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http://www.archive.org/details/souvenirwithautoOObuse 


'DONATIO  PERFICITUR  P0SSES8I0NE  ACCIPIENTIS." 


A    SOUVENIR 


AUTOBIOCRAnilCAL  SKETCH  OF  EARLY  LIFE 


SELECTED  MISCELLANEOUS  ADDRESSES 
AND  COMMUNICATIONS. 


BY 

SAMUEL  CLAGETT  BUSEY,  M.D.,  LL.D., 

PRESIDENT  OF  THE  MEDICAL  SOCIETY  OF  THE  DISTRICT  OF  COLUMBIA,  1S77, 1894,  1895, 18% 


CITY  OF    WASHINGTON.   D.  C. 

1896. 


Entered  according  to  the  Act  of  Congress,  in  the  year  1896,  by 

SAMUEL  CLAGETT   BUSEY, 
in  the  ofiSce  of  the  Librarian  of  Congress,  at  "Washington,  D.  C. 


1?  \5^.3^^ 


DORNAN,  PKINTER, 
PHILADELPHIA. 


COxNTENTS. 


PAOR 

A  souvenir         ...........  9 

An  autobiographical  sketch  of  early  life    ......         13 

Birth  and  genealogy,  14;  mother  and  father,  10;  Clagett 
family  and  genealogy,  17  ;  Clagett  Wliite  and  family,  18  ;  Uncle 
Will  and  Aunt  Hannah,  19;  Bethesda  Church,  21;  William 
Grindage  and  West  Point,  23;  fox-hunting,  24;  Potomac  River 
boatmen,  26;  homestead,  27;  Bowie  Run  and  Cabin  John,  28; 
evening  social  assemblages,  29  ;  tallow-dip  candles,  30 ;  poultry- 
raising,  31  ;  early  period  of  life,  33  ;  pleasures  and  pastimes,  34 ; 
fishing  excursions,  35 ;  snake-hunting,  36 ;  summer  environ- 
ments, 37 ;  autumn  season,  38  ;  nut-gathering,  38 ;  winter  sea- 
son and  evenings,  39  ;  rabbit-catching,  40;  Glen  Echo,  41 ;  Christ- 
mas festivities,  42;  aurora  borealis,  45;  wood-pile,  45;  stormy 
weather,  46 ;  hog-killing,  47  ;  smoke-house,  48 ;  herring-catch- 
ing, 48;  sheep-shearing,  49;  country  weavers,  50;  disappoint- 
ments, 50 ;  Buddy  Gus,  51 ;  hardening  boys,  53  ;  Alfred  and  Tom, 
53,  54;  brother  William,  54;  country  boys,  56,  sickness,  blood 
and  blind  boils,  57 ;  school  days,  59 ;  Nathan  Loughborough, 
60;  lock-out,  61;  orchard  farm,  63,  visits  to  Georgetown,  63; 
market  days,  65  ;  James  Wallace  and  Ellen  Snowden,  66  ;  Fourth 
of  July  Sunday-school,  67  ;  barbecue,  68 ;  inauguration  of  Wil- 
liam Henry  Harrison,  69 ;  visit  to  Congress,  71 ;  Rockville 
Academy,  72;  O.  C.  Wight,  73;  smoking,  74;  visits  to  Spring- 
field, 76  ;  little  sister,  77  ;  slave  families,  78  ;  death  of  wife,  80. 

Address  before  the  Medical  Association  of  the  District  of  Columbia 
on  a  resolution  to  revise  its  code  of  ethics  and  regulations      .         .       83 

Gathering,  packing,  transportation,  and  sale  of  fresh  vegetables  and 
fruits ;  their  chemical  constitution  and  nutritive  value  ;  competent 
inspection  and  free  markets  for  producers       .         .         .         .         .       87 

Address  in  nbstretics  and  diseases  of  women  and  children  .         .         .     120 
Utilizing  power  in  head-last  labor,   121 ;   correction  of  face 
presentations,  122  ;  the  sericeps,  123;  obstetrical  extractors,  125; 
transfusion,  127  :  puerperal  fever,  130 ;  puerperal  eclampsia,  139  : 
menstruation,  146;  uterine  fibroids,  147. 


vi  C0NTE2^TS. 

PAGE 

Address  delivered  at  the  twenty-eighth  annual  commencement  of  the 
Medical  Department  of  the  University  of  Georgetown     .         .         .     148 

Eulogy  on  Dr.  William  Beverly  Drinkard 159 

The  Columbia  Hospital  and  Lying-in  Asylum,  a  government  institu- 
tion ;  its  past  and  present  management    .         .         .         .         .         .163 

Washington  malaria  and  the  catching  of  cold 180 

Differential  diagnosis,  181  ;  generation  of  miasmata,  182;  to- 
pography and  sewerage,  184  ;  water-level,  193;  ground-air,  195; 
ventilation  and  draught,  200  ;  density  of  population,  201 ;  abate- 
ment of  evils,  202;  clinical  pictures,  203;  catching  of  cold,  204; 
its  symptomatic  phenomena,  207  ;  the  fons  et  origo  of  indetinite 
ailments,   214;  effects  of  refrigeration,    216;    alcoholism,    218; 
fever  and  ague,  219;  contest  of  pleasure,  220. 
First  annual  address  of  the  President,  delivered  before  the  Wash- 
ington Obstetrical  and  Gynecological  Society,  October,  1883  .         .     221 
Craniotomy  upon  the  living  foetus  is  not  justifiable,  221,  223; 
craniotomy  an  ancient  operation,  224;  mortality  studied  chrono- 
logically, 225;  successful  crauiotomist  influenced  by  ambition, 
225 ;  multiple  Csesarean  sections,  226 ;  operative  substitutes  for 
craniotomy,  227;  induction  of  premature  labor,  232;   criminal 
abortion,   233 ;  revival  of  Sigaultian  operation,   233 ;    Cesarean 
section  and  substitutes,  235;   Porro  operation,   237;    Lungren, 
237;  Prof.  Eustache,  239;  nature  will  do  much,  2^0;  right  of 
election,  241 ;  relative  value  of  lives,  242  ;  laws  of  moral  respon- 
sibilities, 243 ;  diagnosis,  244. 
Prseses  et  rector,  degree  of  LL.  D.      ......         .     245 

Address  of  welcome  to  the  American  Gynecological  Society,  delivered 

at  Washington,  September  22,  1885 247 

The  hygiene  of  pregnancy,  delivered  by  the  President  of  the  Wash- 
ington Obstetrical  and  Gynecological  Society,  October  2,  1885         .     249 
Changes  consequent  upon  pregnancy,  250  ;  changes  in  blood, 
251 ;   changes  in  glandular  system,  252 ;   changes  in  secretory 
and  excretory  glands,  252 ;  changes  in  mammary  glands,  252 ; 
studies  in  the  lymphatic  system,  253 ;  physiological  leucocytosis, 
254 ;   liver  and  kidney,   255 ;   physiological  albuminuria,  257  ; 
similar  phenomena,  258 ;  management  of  pregnancy,  259. 
Address  of  welcome  delivered  to  the  Congress  of  American  Physi- 
cians and  Surgeons,  September  18,  1888          .....     263 
First  assemblage  of  Congress,  263;  Index  Catalogue  and  gov- 
ernment bureaus,  265 ;  generosity  of  the  government,  266  ;  rela- 
tion of  government  to  city,  267. 
Address  of  welcome  to  the  American  Gynecological  Society,  delivered 
at  Washington,  September  18,  1888 269 


CONTENTS.  vii 

PAoe 

Tho  wron^  of  (ininiotoiiiy  upon  the  living  fu-tUH  ....     270 

I'roviouH  priidiclioii,  271;  Ihwuc  pl.-iinly  Htated,  272;    right  or 
wroiif^   of  criiniolomy,    '2T''> ;    not    a   crirno,    273;    frequency  of 
openition,    275;    concei)tion,    275;    tnotlier's  love   of  oflHpring, 
277;  criminal  abortion,  278 ;  brutal  epoch  of  craniotomy,  279 ; 
percentage  of  craniotomy,  281  ;  McDowell  and  ovariotomy,  281  ; 
alternative  procedures  give  better  results,  285 ;  Barnes's  conclu- 
sions, 284;  final  comparison,  280;  percentage  of  lives  saved,  287  ; 
uncertainties  of  life,  288;  right  of  selection,  288;  craniotomy 
indirect  killing  of  aggressor,  289  ;  final  statistics,  291. 
The  Hospital  for  ( 'ontagious  Diseases         ......     291 

Address  of  the  President  at   the   seventy-fifth    anniversary  of  the 

Medical  Hocicty  of  the  District  of  (Jolumbia,  l-'ebruary  IfJ,  1894    .     295 
After-dinner  speech  at  banquet,  February  K),  1894    ....     301 

Address  of  welcome  to  the  Association  of  Military  Surgeons,  delivered 

at  Washington,  May  1,  1894 304 

Early  condition  of  city,  306 ;  condition  during  the  war,  307  ; 
progress  since  the  war,  308  ;  power  of  the  profession,  309. 
The  Medical  Society  of  the  District  of  Columbia  in  1894,  with  some 
important   recommendations.      Annual  address  of  the  President, 

delivered  December  19,  1894 310 

Progress   of    tlie   Society,    311,    314;    milk   legislation,   314; 
amendments   suggested,  315;   membership    by   invitation,  317  ; 
organization  of  Medical   Association,   318 ;    revolt  of  citizens, 
319;    health  department,  320;   study  of  morbid  preparations, 
324;  duty  of  young  members,  325  ;  erection  of  suitable  building, 
326 ;  succession  in  office  of  President,  327. 
Address  of  welcome  to  the  Southern   Surgical   and  Gynecological 
Society,  delivered  at  Washington,  November  12,  1895    .         .         .     329 
Government  realty  in  District  of  Columbia,  332  ;  Government 
Bureax  of  Science,  336  ;  medical  colleges  and  societies  in  District 
of  Columbia,  334. 
Annual  address  of  the  President  of  the  Medical  Society  of  the  Dis- 
trict of  Columbia,  delivered  December  18,  1895      ....     335 
Continual  progress  of  the  Society,  336  ;  milk  legislation,  337  ; 
protest  of  committee  to  Senate  amendment  to  milk  bill,  338 ; 
report  on   zymotic   diseases,  341 ;    medical   practice   law,  342 ; 
protest  of  committee  to  commissioners'  amendment,  346 ;   Dr. 
Custis,   letter  of,  349 ;  conclusion  from  previous  history,  351  ; 
medical  schools  and  societies  in  the  District  of  Columbia,  352 ; 
classification  of  medical  practice  laws  in  States,  353  ;  Society 
Transactions,  357. 
Eeport  of  committee  on  bill  relating  to  testimony  of  physicians  in 
the  courts  iu  the  District  of  Columbia     ......     363 


viii  CONTENTS. 

'  PAGE 

Eulogy  on  Dr.  Joseph  Meredith  Toner,  delivered  by  the  President 
of  the  Medical  Society  of  the  District  of  Columbia,  October  21, 

1896        ..." .368 

The  year  1896:  an  epoch  in  the  history  of  the  Medical  Society  of 
the  District  of  Columbia ;  annual  address  delivered  by  the  Presi- 
dent, December  16,  1896 372 

Medical  practice  act,  373;  medical  college  law,  375;  medical 
testimony  act,  376 ;  sanitation  legislation,  377 ;  publication  of 
Transactions,  379;  epoch  year,  381. 


A  SOUVENIR. 


In  consequence  of  an  nnfortimato  accident,  which  occurred 
on  April  5,  1895, 1  am  no  longer  able,  because  of  physical  dis- 
abilities, to  pursue,  except  to  a  very  limited  extent,  the  active 
duties  of  my  profession,  and  am,  therefore,  compelled  to  seek 
diversion  and  employment  in  my  library,  engaged  in  such 
literary  pursuit  as  may,  from  time  to  time,  give  pleasure  and 
relief  from  the  monotony  of  such  enforced  retirement  and 
seclusion  from  the  activities  and  responsibilities  to  which  a 
long  aud  laborious  life  had  become  inured. 

During  the  waking  hours  of  such  a  life  of  physical  in- 
capacity, not  wholly  free  from  suffering,  the  mind  naturally 
dwells  upon  the  friendships  and  good  wishes  of  those  who 
have  so  often  and  so  kindly,  in  some  one  of  many  ways, 
manifested  the  fulness  of  their  sympathy  and  personal  regard, 
that  I  have  sought  some  satisfactory  and  appropriate  method 
of  giving  expression  to  reciprocal  esteem  which  such  valued 
friends  might  hold  as  a  memorial  in  remembrance  of  one 
who  wishes  to  acknowledge  the  obligations  of  gratitude. 

How  best  to  accomplish  this  purpose  and  not  transgress 
the  limits  of  good  taste  aud  punctilio  has  been  a  subject  of 
deliberate  consideration,  but  the  final  conclusion  seems  to 
have  been  reached  rather  by  the  process  of  ratiocination 
than  by  inductive  reasoning. 

In  fulfilment  of  this  conclusion  I  have  brought  together 
in  this  volume,  in  the  form  of  a  souvenir,  my  miscellaneous 
addresses  delivered  at  different  times,  and  under  very  vary- 
ing circumstances^  because  they  set  forth  more  distinctly  than 
any  class  of  my  publications  the  trend  of  thought  that  has 

(9) 


10  A  SOUVENIR. 

animated  and  directed  my  professional  life,  believing  that 
such  a  compact  reproduction  would  fully  exhibit  such  special 
characteristics  of  miud  and  thought  as  would  epitomize  my 
life  history  and  present  the  dominant  traits  of  a  long  and 
active  professional  career. 

It  may  be  true  that  this  method  of  giving  expression  to 
my  gratitude  and  regard  for  valued  friendships  will  suggest 
the  insinuation  of  egotism  ;  but  if  so,  it  is  the  egotism  of  that 
independence  of  thought  that  frees  conviction  and  expression 
from  the  restraint  of  some  custom  "  more  honored  in  the 
breach  than  the  observance." 

Those  of  my  friends  who  will  receive  a  copy  of  this 
Souvenir,  and  who  may  choose  to  read  its  pages,  will  not  fail 
to  observe  that  I  have  uniformly  contended  for  the  honor  and 
dignity  of  the  medical  profession,  which  I  have  believed 
could  be  more  effectively  maintained  by  the  dicta  of  a  high 
esprit  de  corps  than  by  the  penal  provisions  of  a  code  of 
ethics  but  rarely  enforced;  that  the  highest  standard  of 
medical  education  was  demanded  by  every  consideration  of 
professional  duty  and  obligation,  and  that  the  profession 
should  assert  its  prerogatives  of  right  and  power,  in  that 
legislators  and  all  others  in  authority  should  come  to  know 
that  science  must  dominate  public  opinion  in  all  matters 
pertaining  to  preventive  and  remedial  medicine.  Whilst  I 
may  not  live  to  witness  the  full  fruition  of  these  aspirations, 
I  have  lived  to  see  such  advanced  progress  in  medical  edu- 
cation that  I  am  not  without  the  hope  of  their  complete 
realization  in  the  near  future.  I  have  not  claimed  origi- 
nality in  these  contentions,  but  have  followed  the  teachings 
of  many  of  the  most  distinguished  and  honored  of  the  pro- 
fession. I  hold,  in  common  with  many  others,  the  belief 
that  scientific  medicine  cannot  attain  the  full  measure  of  its 
beneficence  until  the  profession  in  general  has  attained  that 
standard  of  knowledge  which  only  can  qualify  it  for  the 
performance  of  the  responsible  and  beneficent  duties  and 
obligations  of  a  life-saving  profession.     I  maintain  now,  as 


A  SOUVF.MIl.  11 

I  have  long  ago  announced,  that  a  life  lost  through  ignorance, 
inattention,  or  neglect,  is  Homcthing  more  than  a  mistake 
to  be  appeased  by  one's  complaisant  promise  to  himself  that 
such  wrong  shall  not  again  be  committed.  The  responsibility 
of  misguided  judgment  and  misap])lied  resource  does  not 
cease  with  tlie  conviction  of  right.  Right  or  wrong  cannot 
be  submitted  to  the  arbitrament  of  such  judgment,  nor  dis- 
missed with  the  declaration  of  one's  own  opinion  of  right. 
The  tribunal  of  justice  is  at  the  bar  of  eternity. 

I  take  this  occasion  to  gratify  a  long-cherished  wish  to 
communicate  to  my  colleagues  and  confreres  the  statement  of 
my  firm  belief  in  the  beneficence  and  omnipotence  of  Almighty 
God  and  the  efficacy  of  prayer.  INIy  past  experience  assures 
me  that  sincere  and  prayerful  submission  to  the  will  of  God 
may  displace  doubt  and  fear  with  confidence  and  courage,  and 
that  in  His  wisdom  such  help  may  be  granted  as  will  vouch- 
safe results  not  believed  to  be  otherwise  attainable. 

In  a  recent  publication  entitled  Personal  Reminiscences 
and  Recollections  of  Forty-six  Years'  llembership  in  the  Medi- 
cal Society  of  the  District  of  Columbia  and  Residence  in  this 
City,  I  have  narrated  many  incidents  and  circumstances  of 
my  professional  life  and  associations.  Could  I  have  antici- 
pated the  favor  with  which  that  volume  has  been  received, 
as  well  by  the  lay  as  the  professional  reader,  I  would  have 
added  many  omitted  details  and  incidents,  which,  as  it  seems 
to  me  now,  might  have  enhanced  its  historical  value  and 
interest.  In  the  one  hundred  and  eighty  letters  of  acknowl- 
edgment now  in  my  possession  —  many  of  which  are  from 
members  of  the  immediate  families  or  near  descendants  of 
those  to  whom  reference  was  made  in  the  volume — there  does 
not  appear  one  unpleasant  criticism ;  on  the  contrary,  the 
flattering  commendations  of  those  correspondents,  and  of 
others,  verbally  communicated,  have  been  so  general  that  I 
am  greatly  surprised,  as  expressed  by  one  in  high  educational 
standing,  at  my  "success  as  an  author."  Some  have,  however, 
criticised  the  omissions  of  a  frontispiece  and  an  autobiography 


12  A  SOUVENIR. 

of  my  earlier  life,  which,  in  deference  to  the  suggestions,  I 
now  supply  in  this  Souvenir.  The  following  autobiographical 
sketch  will  relate  to  my  boyhood  life  previous  to  the  com- 
mencement of  the  study  of  medicine.  The  subsequent  events 
and  incidents  of  my  life  have  been  sufficiently  set  forth  in 
the  volume  of  Reminiscences. 

I  have  noted  on  the  title-page  the  successive  years  of  my 
election  to  the  presidency  of  the  Medical  Society  of  the 
District  of  Columbia.  No  other  member  has  attained  to 
this  distinction  since  1866,  the  date  of  its  organization  as  a 
scientific  society  devoted  exclusively  to  the  promotion  and 
dissemination  of  scientific  medicine.  I  recur  to  this  fact 
because  I  value  the  distinction  more  highly  than  any  honor 
that  has  come  to  me  during  my  professional  career,  and  wish 
to  emphasize  the  expression  of  my  grateful  appreciation  that 
those  who  will  come  after  me  may  realize  the  honor  and 
dignity  of  such  distinction. 


AN  AUTOBIOClRArillCAL  SKETCH  OF  EARLY  LIFE. 


I  WAS  born,  July  23,  1828,  on  a  farm  in  Montgomery 
County,  Maryland,  on  which  the  dwelling-house  was  hxated, 
about  one  and  a  half  miles  east  of  Cabin  John  Bridge,  and 
resided  there,  except  during  the  school  sessions  of  (1841-4o) 
the  Rockville  Academy,  until  I  commenced  the  study  of 
medicine  in  the  office  of  Dr.  Hezekiah  Magruder,  in  George- 
town, D.  C,  in  May,  1845.  My  mother,  in  her  last  will 
and  testament,  bequeathed  the  homestead  and  farm  to  my 
elder  half-brother,  Joseph  Gustavus  White,  but  provided  a 
home  at  the  homestead  for  my  brother  William  and  myself 
until  each  of  us  should  reach  the  age  of  twenty-one  years. 
I  relinquished  my  privilege,  and  was  never,  after  her  death, 
at  the  homestead  except  as  a  casual  visitor.  My  mother 
died  in  June,  1844,  aged  fifty-six,  my  half-brother  in  1870, 
aged  forty-nine,  and  my  brother  William  in  1881,  aged 
forty-nine.  Since  the  death  of  William  I  have  been  the 
only  survivor  of  the  immediate  family. 

After  my  half-brother  took  possession  of  the  homestead, 
in  1844,  he  named  it  "Stony  Lonesome,"  because  of  its 
secluded  location  and  peculiar  rock  formations.  In  the 
forest  surrounding  and  near  by  the  dwelling-house  were 
several  enormous  boulders,  rising  from  ten  to  fifteen  feet  in 
height,  and  apparently  so  seated  upon  the  apex  of  sharply 
defined  elevations  that  they  might  be  easily  toppled  over 
and  rolled  down  the  side  of  the  abrupt  knoll.  I  have  occa- 
sionally reached  the  apex  of  some  of  the  boulders  by  swing- 
ing from  the  overhanging  limb  of  a  tree,  and  slided  pre- 
cipitously down  the  rugged  side  to  the  surface  of  the  hill, 

(13) 


14  -  A  SOUVENIR. 

to  the  great  detriment  of  my  clothes,  but  the  amusement  was 
too  rough  for  frequent  repetition. 

John  Busey,  my  father,  was  the  son  of  John  Busey,  and 
was  born  on  a  farm  not  far  distant  from  "Stony  Lonesome," 
but  soon  after  reaching  his  majority  took  up  his  residence 
with  his  uncle,  Samnel  Buse}',  on  the  farm  known  then,  as 
now,  as  Springfield,  situated  on  the  old  river  road  from 
Georgetown  to  the  Great  Falls  of  the  Potomac,  about  one 
mile  east  of  the  Dalecarlia  reservoir.  Springfield  was  pur- 
chased in  1835  by  Peter  D.  Posey,  whose  eldest  daughter  I 
married,  and  is  now  held  by  me,  under  his  will,  in  trust  for 
her  two  surviving  sisters.  After  his  marriage  my  father 
resided  at  the  homestead  of  my  mother,  and  died  there  in 
June,  1832,  of  an  acute  intestinal  aifection. 

Until  a  few  years  ago  I  believed  the  Busey  family,  the 
first  of  whom  settled  in  one  of  the  tobacco-growing  counties 
of  Maryland,  was  of  French  descent,  because  I  had  fre- 
quently seen  the  name  in  French  medical  literature,  but 
spelled  with  an  accent  over  the  letter  e.  After  some  corre- 
spondence witli  a  member  of  a*  family  of  the  same  name, 
residing  at  Urbana,  Illinois,  and  frequent  interviews  with 
the  Hon.  Samuel  T.  Busey,  a  member  of  the  Fifty- second 
Congress,  and  one  of  that  family,  I  became  convinced  of  my 
error  and  of  the  correctness  of  their  investigations,  which 
traced  the  lineage  of  the  family  to  Scottish  origin.  In  proof 
of  the  Scottish  origin,  which  the  Urbana  family  seems  to 
have  established  by  direct  descent,  though  failing  to  name 
the  county  in  which  the  first  emigrant  settled,  they  cite  some 
family  characteristics,  which  I  recognize,  but  I  cannot  con- 
nect my  own  family  either  with  the  Urbana  family  or  with 
any  other  family  bearing  the  same  name  in  any  other  part 
of  the  country. 

The  records  of  the  Land  Office  of  Maryland  show  that, 
in  1754,  the  Lord  Proprietary  patented  to  Edward  Busey 
a  tract  of  land,  designated  "timber  land,"  lying  in  Fred- 
erick County.     The  tradition  is  that  Edward  was  a  Scotch 


SKETCH  OF  KAIU.Y  LII-K  ]5 

emigrant,  who  left  hoiih  niunnd  respectively  Samuel,  John, 
William,  CliarloH,  and  Severn.  After  the  War  of  the  Jievo- 
Intion,  in  whieh  lie  was  a  soldier,  the  family,  or  a  part  of  it, 
moved  to  Virj^juia  and  settled  in  the  vicinity  of  the  town 
now  known  as  Danville.  In  1838  the  survivors  of  the 
emigrants  to  Virginia  moved  to  Tcmnesseo  and  Kentucky, 
and  tiieir  des(!endants  have  scattered  over  the  c<juntry. 

The  same  records  show  that  during  the  years  from  April, 
1775,  to  April,  1820,  five  different  tracts  of  land  lying  in 
Allegheny  County,  Maryland,  were  patented  to  Paul  J3usey, 
Bucey,  or  Bucy,  and  in  1793  a  tract  was  patented  to  Paul 
Busey,  Jr.  The  conne(!tion  between  Edward  and  Paul 
cannot  be  traced.  The  Urbana  family  claim  descent  from 
Matthew  Busey,  Sr.,  who  was  born  in  1742,  settled  in  North 
Carolina,  and  accompanied  Daniel  Boone  to  Kentucky, 
finally  settling  in  Shelby  County  of  that  State.  He  left  a 
large  family.  In  the  families  of  Edward  and  jSIatthew 
Busey  appear  sons  named  Samuel  and  John,  which  names 
reappear  quite  frequently  in  succeeding  generations.  The 
circumstances  of  like  spelling  of  the  names  and  naming  of 
sons,  Samuel  and  John,  connect  Edward  and  Matthew  as 
near  of  kin.  Edward  was  a  land-owner  in  1754,  and  must 
have  been  some  years  the  senior  of  Matthew  ;  but  as  tradition 
omits  the  name  of  INIatthew  from  the  family  of  Edward, 
the  relationship  could  not  have  been  as  near  as  father  and 
son.  My  grandfather  was  named  John  and  his  brother 
Samuel,  my  father  John  and  myself  Samuel.  Samuel,  the 
eldest  son  of  Matthew,  from  whom  the  Urbana  family  claim 
descent,  died  in  Putnam  County,  Indiana,  and  John,  the 
third  son  of  JNIatthew,  died  in  Bourbon  County,  Kentucky. 
As  my  grandfather,  his  brother  and  son  John  (my  father) 
died  in  Montgomery  County,  Maryland,  it  is  very  clear  that 
I  cannot  claim  descent  through  either  of  the  sous  of  Matthew ; 
but  it  appears  very  probable  that  my  grandfather  and  his 
brother  may  have  been  sous  of  Edward,  the  Scotch  emigrant 
and  Revolutiouarv  soldier.     Thev  did  not  s:o  with  the  other 


16  -  A  SOUVENIR. 

members  of  the  family  to  Virginia,  but  remained  in  Mary- 
land. In  some  instances  the  name  has  been  improperly 
spelled  Bussey,  Bucey,  or  Bucy ;  in  fact,  these  discrepancies 
are  to  be  found  in  the  records  of  Paul  Busey,  but  it  seems 
to  be  clearly  established  that  all  of  these  branches,  together 
with  the  numerous  families  spelling  the  name  Busey,  had  a 
common  orio-in,  or  are  descendants  of  either  Edward  or 
Matthew. 

My  father  was  a  gentleman  by  birth,  a  farmer  by  occupa- 
tion, a  politician  by  profession,  a  sportsman  who  kept  packs 
of  trained  hounds  and  horses  to  follow  the  hunt,  and  a  gen- 
erous entertainer.     Of  course,  he  lived  and  died  poor. 

My  recollections  of  his  last  illness  and  death  seem  to  be 
perfectly  distinct  and  clear.  It  is  one  of  the  events  of  my 
early  life  that  has  never  been  forgotten,  but  has  been  kept 
green  in  remembrance  by  very  frequent  recurrence  to  the 
circumstances  that  were  indelibly  impressed  upon  my  memory. 
Early  in  June,  1832,  after  his  return  from  Georgetown,  he 
was  taken  suddenly  ill.  Dr.  James  Wallace,  the  neighbor- 
hood physician,  was  summoned  and  bled  him.  The  next 
day  Dr.  Wootten,  of  Rockville,  was  called  in  consultation. 
They  bled  him  again,  and  again  the  next  day.  His  illness 
was  brief,  not  exceeding  a  week.  I  recall  many  of  the  in- 
cidents of  the  funeral,  the  service  by  Dr.  John  Mines,  the 
baptism  of  my  brother  and  myself,  the  assemblage  of  people, 
the  ride  to  Springfield,  where  he  was  buried,  the  long  pro- 
cession, preceded  by  the  pall-bearers  on  horseback  with  long 
black  sashes  hanging  from  their  hats,  and  the  ride  back  to 
home  with  my  mother.  All  this  appears  so  fresh  and  vivid 
it  must  be  correct. 

My  mother,  Eachel  Clagett,  was  born  in  1788,  at  Weston, 
Prince  George's  County,  Maryland,  two  miles  distant  from 
the  village  of  Upper  Marlborough.  She  was  the  only 
daughter  and  elder  child  of  Thomas  Clagett,  the  seventh  in 
lineal  descent  from  Captain  Thomas  Clagett,  the  emigrant, 
to  whom  a  tract  of  land,  designated  then  and  known  now  as 


SKETdir  OF  /'JARLV  IJFK.  17 

"Weston,"  WiiH  jKiiciilcd  in  1071  by  *' ( 'linrlcH,  abHoliitc  |r)rcl 
and  proprietary  of  tlio  Provinces  oC  Maryliuid  und  Avalon, 
Tvord  liaron  of  lialtimore,"  and  whic;h  liaH  descended  by 
entaihuent  through  eight  generations  to  the  eldest  son,  each 
()M(>  of  whom  was  named  Thomas.  The  last  of  the  eight 
Hii(HH',ssiv(!  holders  of  this  estate  transferred  it  by  will  to  his 
son  Thomas,  and  in  1890  it  was  punihased  at  public  auction 
by  Charles  J.  Bonaparte,  of  Baltimore.  This  sale  naturally 
excites  regret  that  a  descendant  of  such  an  ancestry  should 
have  permitted  such  an  estate  to  pass  away  from  a  family 
which  had  held  it  in  unbroken  descent  for  a  period  of  two 
hundred  and  twenty  years,  and  in  the  soil  of  which,  a  few 
rods  away  from  the  dwelling,  lie  the  remains  of  eight  gen- 
erations of  Thomas  Clagett. 

The  direct  lineal  descent  of  the  Weston  family  from 
Captain  Thomas  Clagett,  the  emigrant,  can  be  established  as 
well  by  records  on  file  as  by  documents  in  the  possession  of 
the  surviving  members  of  the  family.  In  fact,  the  burial 
of  the  successive  generations  of  the  oldest  sons,  named 
Thomas,  at  Weston,  clearly  establishes  the  direct  lineal 
descent  of  the  Weston  family  from  Thomas  Clagett,  to  whom 
Weston  was  granted  in  1671,  and  by  him  conveyed  in  1702 
to  his  sou  Thomas,  with  a  "  remainder  iutail "  to  the  heirs 
of  said  Thomas.  I  refer  exclusively  to  the  direct  line  and 
lateral  branches,  which  spell  their  name  with  one  g  and  a 
double  t. 

It  is  proper  in  this  connection  to  state  that  the  last  who 
inherited  the  estate  by  entailment  was  married  twice.  His 
eldest  son  by  his  first  marriage  was  named  Thomas  William, 
who  left  a  sou  Thomas,  now  residing  at  Keokuk,  Prince 
George  County,  Md.,  whose  eldest  son  is  also  named  Thomas. 
The  Thomas  Clagett  to  whom'  the  estate  was  willed  was  the 
eldest  son  by  his  secoud  marriage  ;  so  that,  by  the  law  of 
primogeniture,  Weston  would  have  descended  through 
Thomas  William  and  the  line  of  his  eldest  sou. 

The  liueal  descent  of  Captain  Thomas  Clagett,  the  emi- 

2 


18  A  SOUVENIR. 

grant,  can  be  established  with  equal  certainty.  He  was  born 
about  1640,  came  to  this  country  in  1670,  and  settled  in 
Calvert  County,  IMd.  His  father,  Edward  Clagett,  married 
a  daughter  of  Thomas  Adams,  Lord  Mayor  of  London  and 
cavalier  during  the  reign  of  Charles  L,  1625-49.  He  named 
his  son,  the  emigrant  Thomas,  after  his  grandfather.  Edward 
was  the  son  of  George  Clagett,  Mayor  of  Canterbury  in  1609, 
1622-32.  Richard,  father  of  George,  was  born  about  1530, 
and  married  a  daughter  of  Sir  Robert  Gouder.  Robert  of 
Mailing,  Kent,  the  father  of  Richard,  was  born  about  1490. 
The  succession  is  from  Robert,  through  Richard,  George, 
Edward,  and  Captain  Thomas  the  emigrant.  Robert  Clagett, 
of  Mailing,  bore  the  arms  of  the  family,  described  as  fol- 
lows :  "  Ermine  on  a  fesse,  sable,  three  pheons,  gold ;  crest, 
an  eagle  head,  erased  ermine,  ducally  crowned,  or  between 
two  wings,  sable." 

A  number  of  the  descendants  of  Captain  Thomas  Clagett 
were  actively  engaged  ill  the  Revolutionary  War  as  private 
soldiers  and  subordinate  officers. 

My  mother  was  married  early  in  life  to  her  first  cousin, 
Clagett  White,  the  only  son  of  Joseph  White,  and  came  with 
him  to  reside  with  his  parents  on  the  farm,  through  which 
the  Washington  aqueduct  passes  for  a  mile  and  a  half  after 
it  crosses  Cabin  John,  and  continued  to  reside  there  for  some 
years,  until  that  part  of  the  house  on  '' Stony  Lonesome" 
was  built,  as  shown  on  the  right  in  the  illustration.  The 
ruins  of  the  old  house  on  the  river  farm  were  removed  when 
excavating  for  the  aqueduct,  and  now  I  can  only  locate  it 
by  the  proximity  of  a  spring.  The  White  family  grave- 
yard, not  far  from  the  dwelling,  has  been  so  completely 
obliterated  that  I  cannot  designate  the  spot  where  lie  the 
remains  of  several  generations  of  a  family  which  ceased  to 
exist  with  the  death  of  my  half-brother. 

After  the  removal  of  Clagett  White  and  his  family,  con- 
sisting of  his  wife  (afterward  my  mother)  and  surviving 
children,  a  son  and  daughter,  and  the  death  of  his  parents, 


HI 

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SKETCH  OF  I'JAnLV  [JFI'l  19 

the  dwelling  on  tlie  river  fui'in  was  o('cii])ied  l>y  two  old 
negrocH,  Uncle  Will  and  Aunt  Ilannuli.  They  were  left 
there  to  take  care  of  the  dwelling  and  generally  to  guard 
the  farm.  Hannah  had  been  the  cook  of  the  White  family, 
and  Will  the  body-servant  of  his  master,  Joseph  White. 
The  old  retired  servants  employed  and  atinised  themselves 
as  best  suited  Iheir  pleasure  and  inclinations.  Hannah  had 
her  gardeu-patcdi  for  vegetables  and  herbs,  cow,  chickens, 
and  pet  eat  and  dog.  During  peach-season  she  prepared  a 
conserve,  which  she  called  "peach-cloth,"  by  spreading  in  a 
thin  layer  on  a  smooth  hard  board  the  mashed  pulp  of  soft, 
juicy  peaches  and  drying  it  in  the  sun.  When  sufficiently 
dry  she  cut  it  into  long  strips  several  inches  wide,  rolled  the 
strips  into  rolls  two  or  three  inches  thick,  and  packed  them 
away  for  winter  use.  It  was  not  a  very  toothsome  delicacy, 
but  served  as  a  very  good  swap  for  anything  I  might  carry 
to  her  from  the  family  table,  and  she  took  great  pleasure  in 
stuffing  into  my  coat  pocket  one  or  more  rolls.  Uncle  Will 
was  a  rough  carpenter  and  occupied  himself,  when  it  suited 
his  amiable  disposition,  in  making  baskets  and  chair-seats 
of  white-oak  splints,  door-mats  of  corn-shucks,  axe-helves, 
hoe-handles,  toy  wagons  and  sleds,  and  foot-stools,  which  he 
sold  or  gave  away  as  might  be  his  pleasure.  His  baskets 
and  mats  were  neatly  made  and  found  ready  sale.  I  have 
seen  and  probably  have  slept  upon  bed-bottoms  made  by  him 
of  splints. 

I  made  frequent  visits  to  the  old  people  in  their  lonely 
home  by  the  river,  and  listened  with  great  pleasure  to  their 
tales  of  life  long  gone  before,  and  especially  to  the  stories 
of  old  Marsa  Joe,  w^ho  must  have  been  a  lively,  if  not  a 
unique  character.  On  one  occasion  he  ordered  them  to  lay 
him  out  for  dead  in  the  kitchen,  and  after  he  had  been  thus 
prepared,  and  stretched  out  at  full  length  on  the  cooling- 
board,  with  a  copper  cent  of  that  date  on  each  eye  to  keep 
the  lids  closed,  he  ordered  them  to  take  the  corpse  into  the 
dwelling-house.     In  doing  so  they  struck  his  head  against 


20  ^  SOUVENIR. 

the  sharp  edge  of  the  chimney-jamb,  whereupon  he  damned 
them  for  their  cruel  treatment  of  a  dead  man.  After  being 
safely  carried  to  his  room  he  ordered  them  to  sit  by  his 
side  until  the  funeral  service  began.  There  he  slept  until 
awakened  in  the  full  consciousness  of  his  freak,  but  offered 
no  explanation  for  his  conduct. 

After  the  death  of  Uncle  Will,  Aunt  Hannah  was  re- 
moved with  all  her  belongings  to  a  quarter  at  the  home- 
stead, where  she  lived  for  some  years  in  great  comfort, 
beloved  and  venerated  by  the  family  of  slaves,  and  respected 
by  everybody  who  knew  her.  During  her  later  years  she 
occupied  herself  for  the  most  part  in  knitting  stockings  for 
her  slave  companions. 

My  mother  was  endowed  with  great  force  of  character 
and  energy,  though  always,  during  my  boyhood  life,  in  feeble 
health.  She  managed  her  farming  operations  and  conducted 
her  business  matters,  sold  the  products  of  the  farm,  and 
made  all  purchases  in  person,  but  kept  employed  a  white 
head-man,  who  was  known  as  the  overseer,  whose  duties 
were  limited  to  the  execution  of  her  orders.  During  the 
planting,  growing,  and  harvesting  seasons  she  inspected  the 
farming  operations  on  horseback  at  sufficiently  short  in- 
tervals to  keep  herself  well  informed  in  regard  to  the  prog- 
ress of  the  work.  On  such  occasions  I  rode  behind  her 
until  I  was  old  enough  to  be  trusted  alone  on  horseback. 

She  was  frugal  in  her  habits,  lived  in  the  ordinary  com- 
fort and  abundance  of  a  prosperous  farmer  in  those  econom- 
ical times,  was  retiring  and  exclusive  in  social  life,  generous 
to  a  fault,  and  charitable  to  the  neighborhood  sick  and 
needy.  Her  charity  did  not  wait  solicitation,  but  sought 
the  opjjortunity  to  oifer  and  give  whatever  would  contribute 
to  the  comfort  and  supply  the  necessities  of  those  who  would 
accept  her  donations  and  free-will  offerings.  Her  larder 
was  always  open  to  the  neighborhood  poor  and  sick,  and  to 
some  others  who  choose  to  tax  her  generosity  by  a  system  of 
borrowing. 


SKETCir  OF  I'JA/if.V  UFE.  21 

She  was  a  coiiHistciit  but  Hoiuowhat  aiiHtcn;  iiDmiriiinicant 
of  the  Presbyterian  denomination,  and  attended  service  on 
alternate  SimdayH  nt  IJctliesda,  some  miles  distant  on  the 
Kookville  tiirn|)ik(!,  and  on  intervening  Sundays  attend<;d 
the  Concord  Methodist  Church,  a  half-mile  distant  from  the 
dwelling.  Sunday  was  a  day  of  rest  and  religious  observ- 
ance, T  was  not  allowed  to  go  fishing,  to  bathe  in  the 
streams,  to  visit,  play  marbles,  go  barefooted,  ride  stick- 
horses,  or  even  set  my  rabbit-traps.  I  kept  on  hand  a  large 
and  well-selected  stud  of  sleek  prancing  and  racing  steeds, 
and  enjoyed  the  sport  of  fretting  myself  in  speeding  and 
jumping  the  nimble  animals  with  amazing  delight;  nor 
could  I  understand  why  setting  my  rabbit-traps  late  Sunday 
afternoon  and  catching  the  hare  early  Monday  morning  was 
any  more  of  a  sin  than  setting  them  on  Saturday  afternoon 
and  leaving  the  animals  in  the  trap  until  Monday  morning, 
but  I  obeyed  the  edict,  made  a  "joy  of  duty,"  and  went  to 
Sunday-school  and  church  service  unless  the  elements  were 
in  such  tempest  that  a  country  boy  could  not  get  outside  of 
the  front  door,  and,  after  returning  home,  whiled  away  the 
afternoon  in  such  harmless  dull  pastimes  as  would  not  offend 
the  keenest  conception  of  innocent  amusement.  I  did  not 
have  the  resources  of  a  schoolboy,  for  I  had  not  then  tasted 
of  the  wonderful  and  ingenious  devices  of  pleasure  which 
add  so  much  charm  to  country  schoolboy  companionship, 
and  make  the  life  of  those  early  years  so  impressive  and 
attractive  that  one,  even  in  old  age,  feels  like  wishing  to  live 
them  over  again.  The  most  of  such  afternoons  were  passed, 
during  proper  seasons,  in  strutting  about  the  lawn,  clothed 
and  booted  in  Sunday-go-to-meeting  attire,  sniffing  the  air, 
chasing  beetles,  and  plucking  butterflies ;  and  when  confined 
to  the  house,  lounging  from  chair  to  chair  or  romping  and 
loafing  from  room  to  room  in  impatient  and  aimless  search 
for  something  different  or  not  to  do.  I  must,  however,  add 
that  during  the  later  years  of  my  mother's  lifetime,  when  at 
home,  Bible  and  Scriptural  reading  was  a  pleasant  part  of 


22  A  SOUVENIR. 

my  Sunday  observances,  and  became  sufficiently  attractive 
to  suggest  the  belief  that  I  would  eventually  enter  the  min- 
istry, but  nothing  in  those  days  could  divert  my  love  for  the 
farm  and  country  life,  which  seemed  replete  with  the  joys 
and  pleasures  M^hich  bring  contentment  and  happiness. 

The  old  one-story  stone  church,  with  a  high  pulpit  opposite 
the  only  entrance  door,  was  destroyed  by  fire  many  years  ago. 
A  more  commodious  building  was  erected  soon  after  the  fire, 
near  where  the  old  church  stood,  in  which  the  congregation 
has  continued  to  worship,  but  few  of  those  who  attended 
Sunday-school  with  me  are  now  living.  During  service  the 
men  and  women  sat  on  opposite  sides  of  the  church.  Chil- 
dren occupied  the  pews  with  their  mothers.  As  a  rule,  the 
men  did  not  enter  the  church  until  the  service  began,  but 
remained  outside  about  the  doorway,  engaged  in  conversation 
concerning  crops  and  farming  prospects  in  general.  Since  I 
left  the  Sunday-school  class,  September,  1841,  the  neighbor- 
hood and  vicinity  of  the  old  church  have  so  greatly  changed 
that  but  few  of  the  landmarks  remain  to  revive  the  memo- 
ries of  that  long-past  period. 

My  mother  lived  to  see  my  half-brother  complete  his  edu- 
cation at  Benjamin  Hallowell's  academy  in  Alexandria,  Va., 
where  so  many  young  men  had  been  thoroughly  equipped 
for  intellectual  occupations,  take  possession  of  his  very  large 
landed  and  personal  estate,  and  prosecute  his  chosen  occupa- 
tion of  farming  with  such  energy  and  so  much  success  as  to 
make  him  her  exemplar  of  the  mature  life  of  her  two  minor 
sons.  But  her  profound  and  unremitting  concern  for  our 
future  welfare  never  abated  one  "jot  or  tittle,"  and  during 
the  last  hours  of  life  she  gave  expression,  in  the  hopeful 
words  of  a  Christian  mother,  to  her  love  and  good  wishes 
for  our  welfare,  prosperity,  and  happiness,  and  with  her  last 
words,  audibly  but  feebly  spoken,  she  placed  in  the  right 
hand  of  each  of  us  a  gold  coin,  the  minted  seal  of  her  en- 
during love.  During  the  past  fifty-two  years  the  recollection 
of  that  scene  has  so  often  come  back  to  me  more  vividly 


SKETfin  OF  I'JAnnv  ufe.  23 

with  each  HiK!OCHsiv(!  im[)r('s,si()ii  upon  llic  incrnory,  until  now 
I  see  the  dream-picture  of  her  last  lioiirs  nidolciit  with  all 
i\w.  saintly  <|ii!iliti(!S  of  a  Clirl.stian  woman  and  lovin;^  motlu-r, 
wlio  wished  to  live  that  .she  might  continiif;  to  foster  and 
watxili  over  the  lives  of  her  minor  sons. 

She  was  (iarefnl  (o  inoidejito  the  hif^hcst  ((ualitics  of  good 
morals,  probity,  and  frugality,  l)ut  was,  perhaps,  more  espe- 
cially concerned  in  regard  to  our  education.  She  knew  the 
very  moderate  income  which  we  would  inherit  would  be 
insuflicicnt  to  defray  the  necessary  expenses  of  such  educa- 
tion as  she  desired  us  to  obtain,  and  never  failed  to  impress 
upon  us  the  importance  of  diligence  in  the  acquisition  of 
learning. 

During  the  last  year  of  her  life  I  was  oflfered,  through  the 
influence  of  William  Grindage,  of  Georgetown,  a  life-long 
and  devoted  friend  of  my  father,  the  prospective  appoint- 
ment to  West  Point;  but  my  mother  refused  her  consent, 
and  persistently  designated  the  profession  of  medicine  for 
mc,  which  I  as  stubbornly  declined,  until  I  came  to  know, 
after  her  death,  that  she  had  done  as  she  had  often  said  she 
would  do,  given  her  entire  realty  to  my  half-brother,  on  the 
condition  that  he  would  pay  to  my  brother,  William,  at  his 
majority,  a  stipulated  sum  of  money,  giving  as  the  reason 
for  such  bequest  that  it  would  be  unwise  to  give  either  of 
the  minor  sons  any  part  of  her  landed  estate,  because  it  was 
entirely  surroimded  by  the  lands  of  our  half-brother.  My 
half-brother's  fortune  was  wasted  through  inattention  to 
business  and  security  obligations,  and  he  died  so  poor  that 
his  estate  was  consumed  in  the  payment  of  such  debts. 

My  mother  left  a  small  estate,  which  she  so  distributed  as 
to  equalize  the  incomes  of  my  brother  and  myself,  giving  to 
me  the  less  part,  because  I  had  inherited,  by  the  will  of 
my  great-uncle,  Samuel  Busey,  one-third  of  his  estate,  but 
which,  with  the  addition  derived  from  my  mother's  estate, 
yielded  an  inadequate  income  for  my  support  and  education 
even  in  those  days  of  frugality  and  rigid  economy.     So  that 


24  ^  SOUVENIR. 

long  before  I  obtained  my  degree  in  medicine  the  principal 
had  been  greatly  diminished.  My  mother  made  William 
Griudage  my  testamentary  guardian,  which  he  declined. 
According  to  the  law  in  Maryland  at  that  time,  I  was  old 
enough  to  select  his  successor,  and  was  summoned  before  the 
Orphans'  Court  to  announce  formally  and  solemnly  my 
selection.  I  named  my  half-brother,  but,  in  fact,  from  that 
date  I  managed  my  small  estate  as  best  I  could,  with  the 
advice  and  occasional  assistance  of  my  best  friend,  William 
Grindage.  He  made  to  me  all  necessary  advances  of  money 
when  my  income  fell  short,  and  never,  during  his  lifetime, 
allowed  me  to  want  for  anything  necessary  for  my  actual 
personal  comfort  or  educational  expenses,  and,  even  after  I 
was  married,  I  knew  where  to  apply  for  temporary  help  to 
make  good  small  shortages  of  money.  When,  in  1849,  I 
bought  the  lot  on  which  I  proceeded  to  erect  a  small  dwell- 
ing-house, I  borrowed  from  him  every  dollar  of  the  purchase- 
money  upon  my  personal  note,  payable  at  my  convenience. 
He  was  a  bachelor  and  lived  to  old  age.  I  do  not  know 
that  any  relative  or  connection  of  his  is  now  living,  never- 
theless I  make  this  record  of  my  grateful  appreciation  of 
his  kindness  and  in  memory  of  his  exemplary  character  and 
goodness  of  heart. 

In  a  previous  paragraph  (p.  16)  I  have  referred  to  my 
father's  love  of  the  chase,  to  which  he  devoted  annually  the 
most  of  his  life,  between  the  times  of  fall  wheat-seeding  and 
spring  corn-planting,  with  an  occasional  diversion  at  the 
race-course,  which  my  indistinct  memory  locates  in  the 
suburbs  of  this  city,  in  the  immediate  neighborhood  of  the 
thriving  village  of  Mount  Pleasant.  I  recur  to  these  facts 
and  circumstances  because  of  the  interesting  recollections 
of  the  lives  of  the  lovers  of  the  chase  in  those  days,  as  told 
to  me  by  my  mother.  I  was  not  quite  five  years  old  when 
my  father  died,  and  have  no  personal  knowledge  of  the 
sport  beyond  the  brief  but  familiar  acquaintance  with  old 
^'  Vanity,"  the  famous  leader  of  the   hounds,  and  the  two 


SKKTCir  OF  I'LMil,)'  fJF/:.  25 

hunters.  "Jolly,"  ilic  favorite,  was  an  u^Iy  holj-tailcd, 
mottle-colored  beast,  which  spiked  his  cars  at  blow  of  horn, 
and  followed  the  hunt  with  f(!rocions  speed;  and  "Gin,"  the 
occasional  substitute,  to  whose  easy  and  steady  gallop  I  be- 
came accustomed  during  the  later  years  of  her  retirement 
from  the  sportsman's  saddle.  Notwithstanding  my  mother's 
antipathy  to  fox-hunting,  she  ])rovided  very  carefully  for  the 
keep  of  these  ajiimals,  which  lived  to  a  good  old  age  and 
died  natural  deaths. 

The  story,  as  told  by  her,  is  as  follows :  There  was  a 
coterie,  it  might  be  called  a  club  nowadays,  of  an  indefinite 
half-dozen  gentlemen  of  reputed  inherited  wealth,  residing 
within  the  limits  of  a  sparsely  populated  country  neighbor- 
hood, on  farms  descended  to  them  through  a  line  of  colonial 
ancestry,  and  dwelling  in  mansion-houses  mostly  built  of 
stone  or  brick.  They  assembled  daily  on  weekdays,  for  the 
start,  at  the  house  of  some  one  of  them,  at  early  breakfast, 
and  again  at  the  house  of  another,  after  the  finish,  at  late 
dinner.  They  came  with  out-riders,  slave  body-servants, 
and  the  hounds  of  their  respective  kennels.  The  meals  were 
very  heavy  and  sumptuous,  consisting  of  the  best  cuts  of 
beef,  or  a  whole  mutton  butchered  for  the  occasion,  and  such 
other  products  as  the  farm  might  afford,  with  apple-jack  and 
peach-brandy,  the  only  domestic  distillery  products  of  that 
vicinity  in  those  days.  The  preparation  of  these  feasts  and 
the  clearing  away  of  the  debris  after  the  departure  of  the 
gentlemen,  with  their  out-riders,  horses,  and  dogs,  all  of 
which  had  to  be  entertained  in  the  conventional  style  of  that 
coterie  of  Slite  sportsmen,  imposed  upon  the  good  housewife 
and  her  retinue  of  slave  servants  constant  and  hard  work, 
for  two  days  of  each  week,  from  dawn  of  day  till  late  candle- 
light. The  wear,  tire,  and  tear  of  such  work  was  so  great, 
with  all  the  fun  on  one  side,  that  it  seems  strange  to  me  that 
a  neighborhood  custom  should  have  trespassed  so  far  beyond 
a  humane  consideration  for  the  good  and  indulgent  house- 
wives.     My  mother,  having   haei   previously   a    somewhat 


26  A  SOUVENIR. 

similar,  though  not  quite  such  an  objectionable,  experience 
(luring  her  early  life  at  "Weston,  was  determined,  so  far  as 
she  was  concerned,  to  break  up  the  weekly  entertainments 
of  men,  horses,  and  dogs  before  the  inevitable  results  of 
rained  health  and  fortune  should  reduce  her  to  poverty  and 
bear  her  to  an  untimely  grave.  With  marked  emphasis  in 
her  words  she  has  more  than  once  told  me  how  speedily  and 
easily  she  accomplished  her  Avell-matured  determination. 
Consequently  my  earliest  recollections  of  the  chase  are  lim- 
ited only  to  some  knowledge  of  the  survivors  of  my  father's 
complete  equipment  for  the  hunt. 

Fox-hunting  was,  in  those  days  as  it  is  now,  a  gentleman's 
amusement,  if  chasing  an  innocent  animal  to  his  lair  or  to 
death  by  a  kennel  of  bawling  and  devouring  dogs  that  the 
first  at  the  finish  might,  followed  by  the  yelping  hounds, 
bear  the  brush  in  triumph  back  to  a  sumptuous,  if  not  a 
riotous,  feast,  is  a  rational  enjoyment  for  cultivated  gentle- 
men. Personally,  I  prefer  the  track  of  the  anise-bag  over  a 
selected  course  rather  than  the  trail  of  the  wily  fox,  whose 
astute  instinct  leads  him  to  his  den  by  the  most  circuitous 
and  inaccessible  route,  oftentimes  deep  in  the  wisely  chosen 
and  impregnable  crevices  of  rocky  formations.  The  simple 
but  graphic  story  of  my  father's  devotion  to  the  sport  that 
owes  its  pleasures  to  the  pain  of  the  dumb  animals  excited 
in  me  a  lively  and  lasting  prejudice  against  gaming  the 
animal  for  the  trophies  of  death  and  tail  tufts. 

As  a  matter  of  interesting  history  not  probably  known  to 
many  now  living,  I  feel  at  liberty  to  introduce  a  brief  account 
of  the  terrible  suffering  of  the  Potomac  River  boatmen,  of 
which  I  have  often  heard  my  mother  speak.  Previous  to 
the  construction  of  the  Chesapeake  and  Ohio  Canal  George- 
town, and  probably  the  cities  of  Washington  and  Alexandria, 
received  the  greater  part  of  their  supplies  of  flour  from  the 
mills  on  the  upper  Potomac,  which  were  boated  down  the 
river  in  a  rude  sort  of  float  boats,  carrying  from  eighty  to 
one  hundred  barrels  each.     The  river  is  not  navigable  above 


SKETCH  OF  KAHI,  Y  LIFE.  27 

the  Little  l^^ills^  wliicli  lius  a  lull  of"  tliirty-scvcii  foot.  At 
the  Great  Falls  the  fall  is  seventy-.six  feet  and  nine  inches. 
Between  these  falls  the  river  in  many  plaees  is  very  rapid 
and  shallow,  and  at  many  other  points  its  conrse  is  so  crowded 
with  rocks  and  narrowed  by  islands  that  a  boat  cannot  pass 
and  escape  total  destruction.  In  1784  the  Legislature  of 
Maryland  chartered  the  Potomac  Canal  Company,  which 
constructed  at  considerable  cost  canals  with  locks  around 
these  falls,  widened  and  deepened  the  smaller  channels  around 
the  islands,  which  were  free  from  rocks,  and  in  many  other 
places,  where  practicable,  dug  canals  across  sharp  curves  and 
around  the  rocky  and  shallow  rapids.  In  such  manner  an 
uncertain  and  dangerous  water-way  was  crudely  prepared  for 
navigation  with  flat-bottomed  scows,  handled  exclusively  by 
hand  power,  with  oars  and  push  poles.  One  of  the  worst  of 
the  many  disastrous  parts  of  the  river  was  near  the  d-vvelling 
of  the  White  family,  where  my  mother  resided  during  the 
earlier  period  of  her  married  life.  There  the  wrecked  and 
starving  boatmen  sought  refuge  from  want  and  suffering,  and 
had  to  be  cared  for,  nursed,  and  fed  until  sufficiently  recovered 
to  seek  on  foot  their  homes.  Boats  and  cargoes  were  fre- 
quently lost,  and  many  of  the  boatmen  were  seriously  injured. 
The  homestead  ^vas  situated  about  one  and  a  half  miles 
from  the  Potomac  River,  on  rising  ground,  near  the  conflu- 
ence of  Cabin  John  and  Bowie  Run,  surrounded  by  an  open 
lawn  edged  with  forests  on  the  sloping  hill-sides,  with  a 
kitchen  garden  and  orchard  in  front.  Cabin  John  is  a 
romantic  and  circuitous  stream,  with  rocky  shores,  rushing 
gorges,  dashing  currents,  and  here  and  there  a  smooth  but 
deep  basin  offering  dangerous  allurements  to  the  youthful 
angler  and  swimmer.  The  affluent  branch  courses  through 
meadow  lands  where  snakes  abound  and  the  meadow-larks 
and  bob-o-links  hide  their  nests  and  young  from  intrusion. 
Along  its  way  it  receives  the  spring  streams  flowing  through 
the  fields  and  down  the  ravines  of  its  picturesque  watershed 
of  rolling  and  forest  lauds,  dotted,  in  my  early  life,  here  and 


28  A  SOUVENIR. 

there  with  farm-houses  primitive  in  style  and  with  rude 
accommodations,  heated  only  by  great  fireplaces  with  brass- 
mounted  handirous  of  various  design,  and  illuminated  from 
late  twilight  until  early  bedtime  wnth  home-made  tallow- 
dipped  candles,  and  in  due  seasons  with  great  blazing  wood- 
fires.  Whale-oil  lamps  and  spermaceti  candles  were  reserved 
for  evenings  when  the  country  folks  would  come  to  tea  and 
chat  about  crops,  poultry  prospects,  courtships,  births,  roads, 
weather,  church-going,  fashion,  and  society  and  neighborhood 
doings  in  general. 

How  these  two  streams  derived  their  names  I  do  not 
know,  nor  have  I  ever  heard  any  authoritative  statement  in 
regard  to  the  origin  of  the  names.  It  was  stated  as  a  tradi- 
tion by  some  of  the  old  persons  that  Bowie  Run  had  been 
named  after  an  original  settler,  but  no  one  could  locate  his 
residence.  It  is  a  short  stream,  not  by  its  course,  over  seven 
miles  in  length,  but  drains  a  very  considerable  watershed 
and  fills  to  overflowing  very  rapidly  during  heavy  rains. 
The  legend  of  Cabin  John  was  more  definite,  but  none  the 
less  a  fiction.  The  old  negroes  and  some  of  the  oldest  white 
inhabitants  took  special  pleasure  in  telling  the  story  of  the 
recluse,  Captain  John,  who,  at  some  remotely  early  period, 
had  wandered  from  afar  through  the  primeval  forest  until  he 
reached  its  bank  opposite  the  horseshoe  bend  not  far  below 
its  confluence  with  Bowie  Run,  and  there  stopped  to  rest  in 
the  profound  solitude  of  that  secluded  nook,  undisturbed 
save  by  the  chirping  birds,  "  the  chit-chat  of  an  idle  squirrel," 
and  sound  of  the  splashing  water.  Here  he  built  a  rude  log 
cabin,  and  dwelt  in  lonesome  retirement  from  the  world. 
Some  of  the  more  superstitious  negroes  were  wont  to  tell  of 
visions  of  the  grimly  visaged  ghost  of  Captain  John  as  he 
walked  in  silence,  with  axe  in  hand,  up  and  down  the  wood- 
land bank  of  the  rugged  stream,  and  sometimes  when  I  have 
stood  upon  the  opposite  rocky  promontory  in  the  sharp  curve 
of  the  fast  running  water,  I  have  felt  such  a  momentary 
thrill  of  horror  at  the  fleeting  thought  that  the  ghost  of  a 


SKETdll  Oh'  h' A /!/,)'  f, //'■/<:.  29 

fiction  might  hIiow  liis  {^liuslJy  form  and  Hli!irj)one(l  axe  that 
I  have  cluiHcd  iiwuy  ,'it  :i  rapid  speed  from  the  h;iimt<;d  H|K>t 
witlioiit  lookiiifi;  hack  over  my  loft  Hhoiildc-r  (o  sec  if"  tiie 
apparition  was  iu  pursuit. 

The  evening  social  assemblages  of  neighbors  were  occasions 
of  special  enjoyment  to  me.  The  visitors  came  informally 
and  early,  not  by  invitation  but  by  notification  tliat  certain 
persons  would  come  to  tea  on  a  day  named,  always  given  in 
time  to  enable  the  cook  to  be  in  readiness  for  a  full  supply 
of  Maryland  biscuits,  with  such  additional  good  foods  as 
would  complete  the  menu  of  an  abundant  and  sumptuous 
country  supper,  suited  in  variety  and  quantity  to  the  taste  of 
the  fastidious  and  hungry.  The  early  coming  was  a  neces- 
sary prelude  to  the  full  enjoyment  of  the  meal.  It  afforded 
the  opportunity  to  exchange  the  gossipy  chit-chat  of  the 
neighborhood,  and  to  simmer  down  the  newsy  tittle-tattle  to 
such  topics  of  general  conversation  as  would  engage  the 
attention  of  everybody  when  assembled  around  the  table, 
Avhere  everyone  talked  at  the  same  time  and  laughed  out  loud 
or  smiled  in  silent  response  to  the  pervading  conviviality. 
A  country  farm-house  supper  of  biscuit,  tea,  and  toothsome 
relishes  seemed  to  inspire  a  well-chosen  company  with  such 
good  cheer  and  bonhomie  as  would  make  every  face  gleam 
and  sparkle  with  delight,  obliterate  the  wrinkles,  furrows, 
and  care  of  advancing  life,  and  add  to  the  freshness  of  youth 
the  glow  and  radiance  of  beaming  festivity. 

Some  of  the  company  were  talkers  from  the  start  to  the 
finish,  with  the  last  word  added ;  and  others  were  loud  and 
jolly  laughers,  all  the  more  so  when  the  repartee  came  quickly 
in  a  sally  of  folk-lore  that  would  capture  general  attention  and 
stampede  the  garrulous  bumpkin  who  sought  to  monopolize 
the  conversation  with  the  pointless  details  of  stale  neighbor- 
hood gossip,  and  did  not  possess  the  suavity  and  ready  wit 
to  conceal  the  discomfiture  of  a  laugh  on  the  wrong  side  of 
the  face. 

On  such  occasions  I  was  duly  instructed  iu  the  proprieties 


30  A  SOUVENIR. 

of  good  behavior  aud  taught  the  lesson  of  how  to  be  seen 
and  not  heard,  but  I  was  not  forbidden  the  privilege  of  being 
honey-fugled  by  some  toothless  spinster  who  claimed  the 
right  of  sealing  her  good-will  and  friendly  slaver  with  a 
righteous  kiss. 

At  supper  I  was  seated  at  a  side  table  and  waited  until  I 
was  served  with  that  which  somebody  thought  was  best  for 
me,  without  the  privilege  of  picking  and  choosing.  I  was 
always  hungry,  but  was  soon  so  comfortably  satisfied  with 
the  good  eatings  that  I  could  listen  in  contentment  to  the 
dialogue  of  the  merry  company,  and  join  in  the  laughter, 
provided  I  was  not  too  boisterous.  Of  course,  sometimes, 
boylike,  I  had  to  laugh  all  around  both  hands  pressed  firmly 
over  my  gaping  mouth,  and  laugh  until  choked,  and  then  the 
maid  would  thump  me  in  the  back  until  I  breathed  easy,  and 
I  was  lucky  if  not  sent  "  in  durance  vile  "  to  weep  and  sleep. 

The  "  tallow-dip  "  candle  was  a  primitive  domestic  manu- 
facture, and  in  many  farm-houses  supplied  all  the  artificial 
illumination  other  than  the  blaze  of  the  open  wood-fires. 
The  method  of  preparation  is  probably  unknown  to  the 
present  generation,  except  perhaps  in  certain  limited  regions 
of  the  country  as  yet  inaccessible  by  the  ordinary  means  of 
transportation.  The  tallow  was  prepared  by  rendering  beef- 
fat  and  was  preserved  in  moulds  or  cakes  until  candle-mak- 
ing time,  usually  during  the  winter  months,  came  around  in 
the  successive  routine  of  the  housewife's  domestic  duties. 
Every  frugal  housekeeper  kept  on  hand,  carefully  and  prop- 
erly prepared,  a  number  of  round,  smooth  candle-dipping 
sticks,  about  tw^o  feet  long  by  one-half  to  three-fourths  of 
an  inch  in  diameter.  Around  these  sticks  the  wick,  cut  in 
fixed  lengths,  was  folded,  six  or  eight  on  each  stick,  and 
twisted  so  that  from  the  loop  surrounding  the  stick  the 
double  wick  would  hang  in  one  straight  line.  A¥hen  thus 
prepared  in  number  to  supply  all  the  candles  for  the  current 
candle-year,  the  sticks  were  hung  in  a  frame  so  made  that 
the  ends  would  rest  upon  two  parallel  bars  with  the  twisted 


SKETCH  01''  /';.!/;/.  K  iji''f':.  31 

wicks  liJiiijL^injz;  dowiiwiird.  Two  or  more  large  iron  pots  or 
other  metal  vessels  were  conveniently  ])laced  near  tliis  frame- 
work uiid  ])artially  filled  with  hot  water,  U))on  which  was 
poured  the  hot  melted  tallow,  filling  the  vessels  hriiiifid.  The 
preparations  being  thus  completed  the  operators  took  each 
sti(^k  in  regidiir  onh-r  and  dipped  the  wick  into  the  hot 
tallow,  with  a  gentle  swaying  motion,  so  that  each  wick 
might  be  thoroughly  saturated  with  the  tallow,  and  when 
withdrawn  each  wick  was  drawn  out  straight  by  pulling 
from  the  end,  before  the  stick  was  replaced  in  the  frame  to 
allow  the  adherent  tallow  to  harden.  This  process  of  dip- 
ping was  repeated  at  sufficient  intervals  until  the  candles 
had  grown  by  the  adhesion  and  congelation  of  the  layers  of 
tallow  to  the  proper  size,  and,  after  hanging  in  the  frame 
until  thoroughly  hardened,  were  stripped  from  the  sticks  and 
stored  away  for  use.  As  thus  made  the  candles  Avere  some- 
what irregular  in  form,  without  smooth  surfaces,  but  the 
tallow  was  a  homogeneous  mass  and  sufficiently  firm  to  retain 
shape  for  a  long  time.  The  tallow-dip  is  not  a  brilliant 
luminaut,  but  in  those  early  days  two  or  more  on  the  centre- 
table  seemed  to  furnish  all  the  light  needed  by  those  accus- 
tomed to  their  use.  They  needed  careful  and  frequent 
snuffing  to  prevent  the  charred  wicks  from  falling  over 
and  dimming  the  light.  I  have  now  in  my  possession  two 
silver-plated  candlesticks,  one  hundred  and  more  years  old, 
in  which  the  tallow-dips  were  set  when  lighted,  by  which  I 
have  read  the  stories  of  Mother  Goose,  and  studied  weather 
prognostics  in  the  Hagerstown  Almanac,  which  was  found 
in  every  farm-house  in  Maryland,  in  company  with  the  Book 
of  Martyrs  and  the  Holy  Bible. 

Poultry-raising  was  one  of  the  economical  industries  of 
good  housewifery,  and  was  made  profitable  by  the  sale  of 
the  surplus  product.  Fricasseed  and  fried  chicken,  baked 
goose  and  duck,  and  roasted  turkey  were  popular  foods,  and 
as  necessary  as  convenient  to  supply  the  requirements  of  the 
farmer's  table.    Poultrv-raising  was  not  in  those  davs  a  hiofh 


32  ^  ^  SOUVENIR. 

art,  requiring  elaborate  and  expensive  preparations,  with  the 
appurtenances  of  glazed  henneries,  incubators,  ornamental 
enclosures,  and  scientific  feeding.  In-and-in,  and  cross- 
breedins:  with  new  and  fancv  kinds  did  not  command  much 
attention.  Fowl  pedigrees  followed  the  survival  of  the  fit- 
test, selected  according  to  taste,  perhaps  most  often  deter- 
mined by  the  color  or  richness  of  the  plumage.  This  was 
certainly  the  custom  in  making  the  choice  of  the  cocks, 
drakes,  ganders,  and  turkey -gobblers. 

The  ordinary  preparations  consisted  of  a  rudely  built 
board  hen-house,  a  thatched  roofed  duckery,  a  turkey-roost, 
reached  by  climbing;  a  goose  shelter,  feed  pens,  and  coops 
for  the  protection  of  the  different  broods  of  the  young. 
With  the  coming  of  springtime  all  these  structures  were 
renovated,  cleansed,  and  put  in  perfect  order,  and  then  fol- 
lowed the  making  of  nests  and  setting  the  eggs.  With  the 
beginning  of  the  hatching  began  the  momentous  cares,  disap- 
pointments, and  anxiety  of  poultry-raising.  The  prepara- 
tion of  foods  for  the  broods  and  the  feeding  required  special 
attention.  Protection  from  cold  and  inclement  weather  was 
equally  important.  Separate  houses  or  coops  and  feeding 
pens  were  provided  for  the  broods  of  the  different  kinds. 
The  brooding  hen  would  pluck  the  turkey-poults  and  the 
gander  would  nip  the  chickabidies  and  ducklings.  Brooding 
fowls  are  not  friendly  to  the  broods  of  other  kinds,  and  some- 
times not  to  those  of  their  own  kind  of  different  age  from 
their  own  broods.  These  circumstances  added  ceaseless  care 
and  vigilance  to  the  duties  of  the  successful  poultry-raiser. 

As  a  small  boy  I  played  the  role  of  a  looker-on,  always 
keenly  alive  with  loving  admiration  for  the  younglings, 
sometimes  joining  in  the  shooing  to  protect  them  from  in- 
imical intruders,  and  occasionally  getting  a  sharp  nip  and 
savage  flap  from  an  angry  gander.  An  old  gander  is  a 
plucky  fowl  and  a  fierce  fighter.  He  does  not  like  anybody, 
but  has  a  special  dislike  for  the  small  boy.  When  the  goose 
is  setting  he  struts  around  or  sits  near  by,  hisses  at  everyone 


SKETCH  OF  EARL  V  fJl''K  83 

wlio  may  approach  the  nest,  uiid  wlicii  tin;  goslingH  arc  about 
his  ferocity  rcjuihcs  Hiujh  (explosive  intensity  that  h<!  will  week 
a  fif>;lit  with  bite  and  blow,  and  wIkmi  the  (!oml)at  is  over  will 
strut  back  to  bis  lilllc!  (lock  and  |)r()udly  cackle  over  his 
triumph.  Tlic  small  boy  may  defend  himself  either  by 
showing  a  pair  of  (;lean  heels  or  standint^  bis  jj^round  armed 
with  a  heavy  stick  twice  as  lon<^  as  the  gander's  neck.  If  he 
succeeds  in  landing  a  vigorous  side  swipe  on  the  neck,  he 
may  knock  out  the  hiss,  but  the  gander  will  ])nt  on  a  good 
face  and  cackle  all  the  same. 

With  such  environment,  and  other  diversions  perhaps 
more  attractive,  to  which  I  will  refer  later,  my  boyhood 
life  ran  its  course  of  joyous  but  heedless  pleasure  and  happi- 
ness from  birth  to  the  death  of  my  mother,  1828-44.  In 
fact,  I  might  with  greater  accuracy  and  propriety  reduce  the 
limit  to  1837,  when  I  began  schoolboy  life  by  going  to  a 
country  school  five  miles  distant  from  the  homestead.  It 
was  during  the  early  period,  before  the  days  of  school  recita- 
tions and  night  school-lessons  at  home  that  the  frivolous  but 
absorbing  pleasures  and  pastimes  of  the  country  boy  so  in- 
delibly impressed  the  mature  man  with  the  vivid  recollec- 
tions of  his  young  life  on  the  farm  and  in  the  open  fields, 
sniffing  the  air  fragrant  with  fresh  vitality  for  the  breath  of 
growing  life,  varying,  with  change  of  season,  in  the  bouquet 
of  growing  and  blooming  plants,  of  ripening  and  harvested 
crops,  of  autumnal  fiiding  and  falling  foliage,  and  wintei^'s 
frosty  and  chilly  blasts  that  swept  the  landscape  and  covered 
the  earth  with  snow  and  ice.  The  seasons  of  hay-making, 
grain-harvesting,  and  corn-shucking  were  times  of  special 
and  busy  delight,  during  which,  at  remitting  intervals  of 
brief  or  long  duration,  as  the  interest  might  persist  or  ooze 
out  in  tire  and  sweat,  I  would  take  a  share  with  a  wooden 
fork  in  thinning  the  rows  of  falling  grass  after  the  scythe,  or 
carrying  sheaves  of  grain  to  the  shocking-places,  or  husking 
corn  in  match  to  count  first  a  fixed  number  of  red  grains 
of  corn,  which   usually  continued  too  long  for   the  joy  of 

3 


34  ^  SOUVENIR. 

winning  and  became  labor  without  fun.  In  spring  and  fall 
fallowing-times  I  would  follow  the  plough  searching  for  worm- 
bait  wherewith  to  angle  the  streams  with  rod,  line,  and  hook; 
and  ride  back  to  the  stable  at  feeding-times  the  beast  of  work, 
which  might  perchance  once  or  more,  with  a  shrug  and  shake 
of  the  body  from  mane  to  tail,  slide  me  off  his  bare  and 
sweating  back ;  or  at  other  times  stroll  the  pathless  woods 
among  primroses  and  violets,  listening  along  the  ramble  to 
the  matching  and  warbling  birds,  and  gathering  nosegays  of 
scented  herbs  and  wholesome  wild  flowers  to  decorate  the 
vases  on  the  parlor-mantle  and  sideboard,  or  selecting  plants 
to  transplant  in  the  flower-beds  on  the  front  lawn ;  and  on 
other  opportune  occasions  plucking  fruit  hanging  in  luscious 
ripeness  from  the  bearing  boughs  of  laden  trees,  or  invading 
the  forbidden  patches  and  bushes  of  the  berry  and  succulent 
fruits  that  had  been  so  carefully  cultivated  for  table  and 
other  domestic  uses ;  or,  with  youthful  rashness,  chasing 
snakes  to  free  the  captured  frogs  from  their  venomous 
jaws;  or,  perchance,  when  the  querulous  bullfrogs  about 
the  muddy  ponds  were  bellowing  in  croaking  cadences, 
would  take  my  chance  with  bean-shooter  at  bull's-eye  gam- 
ing ;  or,  perhaps,  at  late  twilight  catch  toads  luminous  with 
fireflies  gobbled  up  and  guzzled  down,  but  always  careful 
to  avoid  verrucal  infection.  It  was  a  prevalent  superstition 
that  seed -warts  were  due  to  the  inoculation  with  the  renal 
excretion  of  toads,  and  that  the  most  effective  remedy  was 
strangulation  with  horsehair  ligatures  and  dropping  the 
seeds  at  some  road-crossing  whilst  chanting  the  refrain 
"Warts,  warts,  please  leave  me  and  take  the  next  passer-by." 
And  in  later  months,  with  bag  and  pockets,  hunting  chest- 
nuts, chinquapins,  hickory  and  hazelnuts,  to  store  away  for 
winter  festivities  and  nights  of  bellyaches  and  castor-oil, 
which  even  now  make  me  shudder  with  fear  lest  some  grip- 
ing pain  may  disturb  the  peaceful  sleep  of  declining  life. 

The  mere  citation  in  a  running  summary  falls  far  short  of 
giving  expression  to  the  fascination  of  such  pastimes.     No 


SKETCH  OF  EAIU^Y  IJFK  35 

one  but  tli(!  (^oiiiilry  hoy  on  ilic  i\iv\u,  who,  with  han;(l  feet, 
has  followed  along  the  fresh  furrow  of  the  fallow  ])Iough  and 
eaught  the  slimy  earth-worms  as  they  twirled  into  or  out  of 
their  tortuous  ehannels  in  the  upturned  sod,  ean  a])])reeiato 
the  fulness  of  such  pleasure.  There  is  8omethir)g  in  thf; 
odor  of  newly  turned  earth,  in  the  sensation  to  tlu;  tramp- 
ing bared  feet,  and  the  deft  grasp  of  the  worm-l)ait  seeking 
eseape  that  adds  to  })leasure  siu^h  exhilaration  that  thrills 
the  country  boy  Avith  the  eestasy  of  delight.  Not  less  en- 
chanting is  a  ramble  through  the  woods  during  Nature's 
budding  season,  when  the  balmy  air  is  laden  w^ith  the  fra- 
grance of  leafing  and  flowering  undergrowth  and  stately 
trees,  the  woodland  ways  are  shrouded  with  the  changing 
and  dancing  shadows  of  Avaving  boughs  freshly  budding 
with  new  flowers  and  whispering  leaves,  the  birds  are  busy 
building  their  nests  and  singing  to  "call  forth  paramours," 
and  the  welcome  spring  is  painting  the  forest  with  blossoms, 
filling  the  air  with  perfume,  and  covering  the  earth  with 
splendor. 

The  fishing  excursions  were  not  uniform  either  in  their 
pleasure  or  results.  The  glowing  anticipations  of  a  catch 
were  not  always  realized ;  in  fact,  sometimes  the  fishing 
tackle  and  disappointment  were  all  that  was  brought  back 
after  a  half-day's  exposure  to  the  burning  rays  of  the  sun 
on  a  hot  summer  day.  The  patience  and  forbearance  of  a 
lover  of  the  sport  are  not  easily  disturbed  by  disappointment, 
however  much  friends  may  twit  him  for  his  failure.  After 
a  night  of  refreshing  sleep  be  will  be  as  ready  to  repeat  the 
day's  pleasure  as  if  the  catch  on  the  previous  day  had  filled 
full  the  measure  of  his  gratification.  The  youthful  angler 
is,  perhaps,  not  so  patient  and  persistent  in  compensating 
the  disappointment  and  failure  of  to-day  with  the  hope  and 
confidence  of  success  of  to-morrow,  as  he  who  has  followed 
through  several,  and  perhaps  many,  decades  the  pleasure  and 
recreation  of  fishing,  and  can  stand,  day  after  day,  in  patient 
silence  under  the  burning  sun  on  the  fishing-bank,  with 


36  -4  SOUVENIR. 

angle  in  hand,  M'atching  the  bending  reed  from  which  hangs 
the  baited  hook,  without  a  single  pang  of  regret,  even  though 
the  fish  refuse  the  treacherous  bait.  I  did  not  belong  to  the 
obdurate  class  of  Walton's  disciples,  but  fished  to  catch  fish. 
A  good  catch  more  than  compensated  for  muddy  and  torn 
clothes,  dirty  hands,  sore  feet,  and  hunger ;  but  no  catch, 
and  a  poor  catch  only  less  so,  brought  retributive  discontent 
with  tire  and  dumps,  which  were  not  so  completely  obliter- 
ated by  a  night's  sleep  that  I  would  seek  the  repetition  of 
the  excursion  the  next  day.  When  the  day  was  favorable, 
and  the  fish  were  plenty  and  eager  for  the  bait,  the  pleasure 
was  fully  up  to  the  standard  of  highest  enjoyment;  but  when 
the  stream  was  swarming  with  schools  of  mullets  the  hook 
and  line  was  slow  sport  to  mullet-catching,  which  was  ac- 
complished by  driving  one  or  more  schools  along  the  fish- 
ways  up  stream  and  then  obstructing  the  way  with  stones, 
brush,  rails,  or  other  material  at  hand,  so  that  the  fish  could 
not  j)ass,  and  then  going  above  them  and  with  Jong  poles 
thrash  the  water  all  along  behind  them  until  a  shoal  was 
reached,  usually  alongside  of  the  obstructed  fish  way.  When 
landed  on  the  shoal  in  frightened  effort  to  escape  pursuit, 
they  could  be  gathered  up  by  the  hands  in  such  number  as 
would  fill  our  strings  and  nets.  It  was  not,  perhaps,  per- 
fectly fair,  but  it  brought  fun  and  caught  fish  in  abundance, 
and  thus  filled  the  measure  of  the  angler's  highest  aim  and 
sport. 

Snake-hunting  was  not  an  attractive  sport,  but  snake- 
killing  was  a  desperate  duty.  Country  boys  do  not  like 
snakes,  nor  are  they  willing  to  acknowledge  failure  to  kill 
the  reptile  when  the  opportunity  obtrudes  itself.  A  snake 
at  bay,  coiled  upon  itself,  with  head  erect,  glistening  eyes, 
and  sissing  tongue,  showing  fight  and  threatening  attack,  puts 
valor  at  discretion,  and  the  combat  rages  at  safe  distance 
with  stones,  sticks,  and  other  missiles  until  the  reptile  is 
too  much  injured  to  continue  the  fight  and  then  the  killing 
is  completed,  or  it  escapes  by  quick  movement  and  is  not 


SKETCH  OF  EAfiLV  fJFf'J.  37 

pursiuul.  J>iii  wlicii  tli(!  snake  iscaiiglit  witli  llie  hind  l(:^.s(;f' 
11  fVoij!;  [)rojoctin^  IVoin  his  jjiws  the  .sport  of  a  chase  may  not 
be  less  rash,  but  it  is  freer  from  caution  and  more  conch icive 
to  tlie  satisfaction  of  killing.  Such  sport  may  be  lively,  but 
it  is  not  fascinating. 

The  summer  environment  and  amusements  were  the  con- 
tinuation of  the  outdoor  life  and  activities  of  springtime, 
to  \vhi(!h  were  added  the  temptations  and  ravislimcnts  inci- 
dent to  grain-harvesting,  hay-making,  fruit-ripening,  and 
abundance  of  garden  vegetables.  8u(;h  pastoral  ])astiraes 
and  appetizing  inducements  supplied  ample  opportimities  to 
the  country  boy  for  healthful  exercise  and  such  enjoyment 
as  made  life  in  the  open  air  a  fairy  tale  of  joys.  A  tramp 
through  the  stubble  fields,  along  the  banks  of  the  meadow 
streams,  over  the  forest  ways,  and  under  the  orchard  trees, 
with  here  and  there  a  rest  in  shady  nooks  at  full  length  upon 
the  cooling  earth,  with  three  hearty  meals  every  day,  made 
him  as  happy  as  the  days  were  long.  It  was  the  season  of 
sweltering  heat,  bared  feet,  light  clothing,  straw  hats,  bathing 
and  swimming  in  the  shallow  ponds,  basking  in  the  sun- 
shine on  the  sandy  shoals,  and  paddling  up  and  down  over 
the  rocky  bed  and  through  the  splashing  rapids  of  the  crys- 
tal stream.  One  must  have  the  experience  to  realize  the 
rapture  of  such  pleasures.  They  come  aud  go  iu  daily  suc- 
cession free  from  surfeit  and  ennui,  adding  with  each  after- 
coming  day  new  and  queer  phases  to  the  delight  that  make 
the  summer  life  of  the  country  boy  on  the  farm  a  continuous 
series  of  high-jinks,  sport,  fun,  aud  frolic  changing  with  the 
whim  aud  freak  of  boy  nature. 

His  life  of  out-door  activities,  div'ersions,  recreation,  and 
play  developed  very  rapidly  the  intuitive  faculty  of  self- 
adaptation  to  environment  and  to  the  current  and  changing 
conditions  of  season,  weather,  heat,  cold,  and  wet.  He  was 
not  trammelled  by  coddling  parents  and  the  slavish  restraints 
of  society  and  fashion.  His  free  and  easy-going  natural 
life   led   him  along  the   line  of  nature's  allurements   and 


38  ^  SOUVENIR. 

enjoyments,  and  his  quick  and  quaint  perception  of  the 
crude  pleasures  of  farm-life  made  "  the  quips  and  quirks 
and  wanton  wiles"  a  train  of  pastime  and  joy. 

With  the  autumn  came  new  scenes  and  occupations,  not 
less  active  and  enjoyable,  but  less  emotional  and  interchange- 
able, pertaining  more  to  the  practical  and  business  aspects 
of  life  than  to  impromptu  and  sentimental  entertainment. 
The  plundered  orchards,  russet  forests,  falling  leaves,  seared 
fields,  lengthening  shadows,  melancholy  twilights,  and  wail- 
ing winds  were  nature's  warnings  to  prepare  for  the  coming 
winter  festivities.  The  poultry -yard  needed  attention  that 
the  fattened  fowls  might  be  in  condition  for  a  ready  market. 
The  gun  needed  furbishing  and  a  new  flint,  and  the  powder- 
flask  and  shot-pouch  refilling.  The  hunting-dog  must  have 
practice  to  quicken  his  scent,  and  the  beagle-hounds  training 
for  the  rabbit-chase.  The  rabbit  boxes  and  gums  needed  re- 
construction. Squirrel-hunting,  partridge-shooting,  and  rab- 
bit-chasing were  lively  and  attractive  sports,  but  the  econ- 
omic and  penny-making  industries  could  not  be  neglected. 
The  Christmas  season  was  coming  around  again  and  time 
was  growing  shorter  by  counting  the  weeks  passing  fast. 
The  purse  was  in  distress,  Christmas  came  but  once  a  year, 
and  must  be  provided  for  "  by  hook  or  by  crook." 

Nut-gathering  was  a  productive,  though  not  a  profitable 
pleasure.  Perhaps  a  whole  day,  for  which  Saturday  was 
preferable,  would  be  spent  in  thrashing  down  and  hulling 
bushels  and  sometimes  barrels  of  black  walnuts  to  store  away 
and  to  barter  for  Christmas  fire-crackers.  Black  walnut 
trees  were  numerous  and  bore  very  abundantly,  but  home 
consumption  was  large  and  the  market  was  quite  frequently 
overstocked.  Town  people  preferred  the  almond,  shellbark, 
and  pecan  to  the  more  indigestible  and  less  flavored  black 
walnut  and  hickory  nut.  The  hickory  (king  nut)  was 
usually  gathered  after  falling,  but  the  walnut  trees  stood  in 
the  open  fields  or  in  clumps,  and  could  not  be  safely  left  for 
falling-time,  because  of  the  risk  of  losing  the  fruit.     Other 


SKETCH  OF  EARLY  fJFE.  39 

bojH  and  imknowii  infriKlcTH  \v(!r<;  <|iiit(:  ;i3  dili^'ftnt  in 
giitlicrin;^  ihc'ir  Miipplies.  Nut-bouriiif^  trees  and  bushes 
scattered  about  th(!  farm  out  of  the  way  of  direct  and  con- 
stant observation  were  common  property,  and  the  fruit  was 
the  price  of  vigilance  and  industry.  To  secure  a  monopoly 
or  the  lari^er  part  of  the  ])rodi]ct,  it  was  necessaiy  to  thrash 
many  oftlie  trees.  After  Iniliing,  the  nuts  were  dried  in  the 
open  air  and  tiien  stored  away  in  some  dry  place  for  use. 
The  consumption  of  walnuts  l)y  a  country  boy  at  his  inter- 
meal  feasts,  and  especially  in  preparation  for  l)edtime,  is 
only  comparable  to  the  quantity  of  corn  an  adult  duck  will 
consume  if  allowed  to  sip  a  little  water  and  shake  his  tail 
feathers  during  the  feeding,  or  to  the  quantity  of  boiled  com 
a  fattening  hog  will  eat  at  a  siugle  feeding.  Neither  will 
ever  get  enough.  The  hog  possesses  one  great  advantage. 
When  he  has  swallowed  until  he  cannot  hold  another  grain, 
he  will  sit  upon  his  tail  and  scratch  the  roof  of  his  mouth 
with  one  of  his  hind  toes  until  he  vomits,  and  then  return 
to  the  trough  and  eat  with  the  energy  of  a  hungry  beast. 
The  tasteless  greediness  of  the  domestic  duck  is  a  phe- 
nomenon. The  capacity  of  a  country  boy  for  nuts  is  not 
less  remarkable.  He  eats  until  stiff  with  fulness,  and  then 
looks  over  the  empty  hulls  for  the  bits  of  kernels  left  behind. 
Every  season  had  its  pleasure,  and  the  winter-time  had  its 
special  line  of  in-door  and  out-door  amusements,  not,  per- 
haps, so  well  adapted  to  the  restless  and  changing  taste  of 
the  country  boy,  who  lives  and  thrives  on  pleasure,  plain 
food,  and  sound  sleep ;  nevertheless,  not  without  interest  and 
consuming  recreation.  Coasting  down  long  hills  and  away 
into  the  valleys  below,  until  brought  to  an  abrupt  stop  by 
pitching  into  a  frozen  stream  or  against  some  obstruction,  on 
a  rudely  improvised  sled,  was  just  as  wildly  attractive  then 
as  now,  and  bruises,  contusions,  cuts,  and  scratches,  with  torn 
trousers  and  jackets  out  at  elbows,  were  just  as  common  con- 
comitants ;  but  there  were  no  vehicles  to  drive  across  our  icy 
descent,  nor  crowds  of  idle  and  wild  poor  boys  without  sleds 


40  A  SOUVENIR. 

to  jeer  and  ba^yl  at  our  ludicrous  mishaps  aud,  sometimes, 
sharply  painful  cuts  and  other  minor  injuries.  We  were 
sufficiently  prudent  and  philosophic  to  lick  and  hide  the 
wounds  and  coarsely  sew  up  the  tears  and  rips  of  clothing 
before  returning  to  inspection,  lest  the  edict  of  prohibition 
should  be  issued  at  early  breakfast  the  succeeding  morning. 
Then,  too,  we  had  our  field  ponds  and  other  collections  of 
water  for  skating  on  shoes,  and  then  tramping  far  away  to 
the  cobbler  to  have  them  revamped  and  rehalf-soled ;  and 
perhaps,  on  other  days,  when  the  wind  was  cutting  cold  and 
the  earth  and  ice-ponds  were  clad  with  snow,  would  rollick 
about  and  sniff  the  scented  air  of  green  wood  burning  in  the 
forest,  where  the  woodman  was  felling  timber  and  chopping 
back-logs  and  smaller  fuel  for  the  winter  fires  in  the  dwell- 
ing and  greater  fires  in  the  quarters,  and  where  old  Uncle 
Cato,  with  maul  and  wedge,  did  rive  huge  logs  into  rails, 
and,  at  resting  intervals,  piped  himself  full  of  smoke  with 
such  relish  that  blisters  on  his  tongue  did  neither  hurt  nor 
disturb  the  solemn  mirth  of  his  tales  of  "  Jack  the  Giant- 
killer."  Rabbit-trapping  in  boxes  and  gums  was,  however, 
the  most  intensely  absorbing  seasonal  sport.  To  run  at  early 
sunrise  in  high  expectation  and  return  in  gleefid  success 
with  the  living  trophy  held  tight  in  hand  was  fun  in  fact ; 
but  when  the  traps  Avere  empty,  or,  before  I  had  learned 
how  to  garrote  him,  old  "cotton  tail  "  had  escaped  by  jerk- 
ing loose  from  grasp  and  darting  at  double-quick  away 
through  the  undergrowth,  the  gait  of  return  was  slow  and 
careful,  in  thoughtful  preparation  of  an  excuse  for  failure 
to  bag  my  game,  and  then,  at  late  sunset,  having  forgotten 
the  morning  disappointment  and  chagrin,  with  rekindled 
hope,  I  tramped  the  woods  and  ravines  where  timid  rabbits 
did  lightly  tread  the  tiny  paths,  to  bait  the  traps  with  fresh 
food,  and  set  the  triggers  for  easy  fall,  that  I  might  insure  my 
catch  to  replenish  my  Christmas  and  Fourth-of-July  pecuni- 
ary resources.  Eabbits  in  those  days  were  worth  in  open 
market  from  five  to  ten  cents  per  carcass  with  skin  intact. 


SKETC/f  (JF  I':AIU,Y  fJl''h'.  41 

The  later  years  of  tlio  country  boy  were  not  ho  exeluHively 
limited  to  rabbit  catching,  but  were  quite  often  divcrHified 
with  <^iiiiiiin<^  in  jrcMKM'iil  for  game  at  large,  but  mf)re  espe- 
cially with  partridge-shooting,  which  required  more  Hkilful 
handling  of  the  fowling-pieee,  and  wqs  stupidly  dull  :iiid 
fatiguing  to  the  inexpert  guniuir.  There  were  many  other 
by- plays  equally  enticing  and  full  of  frolic  and  merry-mak- 
ing, but  less  engrossing  and  more  evanescent  in  their  hold 
upon  the  exuberant  impulses  and  restless  spirit  of  the  healthy, 
well-fed,  and  vigorous  youth.  Tops,  hops,  kite-flying,  mar- 
bles with  hives  and  feu  hives  for  fun  or  for  keeps,  and  for 
knucks,  mumble-the-peg,  quoits  with  pennies  or  with  blocks 
or  stones,  ball  at  bat  and  sky-ball,  riding  piggy-back,  play- 
ing ducks  and  drakes,  and  other  athletic  sports  of  the  rough- 
and-tumble  sort,  devised  on  the  spur  of  the  moment,  and 
not  always  free  from  a  fight  at  finish,  were  held  in  reserve 
to  drive  away  dull  care. 

It  is  strange,  nevertheless  true,  that  the  location  now 
known  as  Glen  Echo  was  a  part  of  my  rabbit-trapping  and 
hunting-ground,  over  -which  I  have  tramped  through  wind, 
cold,  frost,  and  snow  to  my  traps  and  in  search  of  other 
game.  It  was  then  a  rough  and  neglected  region  and  known 
only  to  those  who  might  tramp  the  pathless  forests  and 
broom-sage  lowlands  with  dogs  and  gun  to  trap  or  chase  the 
rabbit,  or  bag  other  game  which,  at  times,  sought  refuge  in 
the  lonely  forest  and  secluded  valleys  and  raviucs.  It  had 
not  then  engaged  the  speculative  conception  of  the  human 
mind  that  land  that  could  not  find  a  purchaser  at  five  dollars 
per  acre  would  ever  be  subdivided  into  town  lots  and  sold 
by  the  square  foot  at  prices  far  beyond  the  wildest  dream  of 
the  most  visionary  and  reckless  theorist  in  future  gains  and 
profits.  And  even  now,  as  I  drive  along  the  conduit  road 
which  bisects  this  region,  which  recent  romance  and  poetry 
and  financial  wreck  have  made  as  famous  as  the  South  Sea 
Island  bawble,  I  cannot  realize  the  lavish  and  fruitless 
waste  of  money,  taste,  and  enterprise  in  speculative  future 


42  A  SOUVENIR. 

that  decorates  the  lonesome  hunting-grouud  of  my  youth. 
Glen  Echo  ^vith  her  mansions  on  the  sloping  hillsides,  her 
great  Chautauqua  buildings  falling  to  ruin,  the  numerous  un- 
occupied cottages  on  the  level  where  broom-sage  and  poverty 
grass  grew  in  luxuriant  evidence  of  the  poorness  of  the 
soil,  and  the  driveways  over  the  rugged  hills  and  through 
the  primeval  forest,  is  more  desolate  than  when  the  rabbit, 
opossum,  woodcock,  and  other  game  abounded  and  made 
merry  the  sportsman  with  his  gun  and  dog. 

The  Christmas  festivities  began  the  day  before  with  busy 
preparation  for  the  enjoyment  and  merriment  that  were  to 
obliterate  all  the  sorrow  of  the  year  soon  to  close  with  the 
coming  of  the  Avelcome  New-year  Day.  The  final  act  of 
readiness  consisted  in  the  filliuo^  of  the  stockings  of  the  do- 
mestics  hung  to  the  chimney-jamb,  and  arrangement  of  the 
gifts  so  that  each  could  be  conveniently  and  orderly  pre- 
sented to  the  person  for  whom  intended.  Then  to  bed  to 
sleep  through  dreams  of  pleasure  until  the  break  of  day, 
when  the  frost  was  gleaming  in  the  starlight,  the  air  was 
keen  and  crisp,  and  the  great  back-logs  were  simmering  and 
fuming  at  each  end,  whilst  the  smaller  fagots,  piled  thick 
and  high  up  in  the  fireplaces,  were  glowing  with  living 
coals  of  fire,  and  the  roaring  flames  rising  higher  and  higher 
up  the  chimney  were  filling  the  rooms  with  the  warmth  and 
mellow  shadowy  light  of  the  merry  Christmas  fires,  the  slaves 
came  knocking  at  the  windows  and  doors  to  catch  missus 
Christmas  gift  and  to  oifer  some  token  of  their  respect  and 
good- wishes.  Old  Cato  wanted  a  new  wammus ;  Frank,  a 
new  silk  liat  to  don  when  on  the  carriage-box  ;  Lewis,  to- 
bacco and  pipe,  and  a  little  grog  to  limber  up  his  stiffened 
joints ;  old  Charity,  a  new  turban  to  decorate  her  kinky 
head  ;  Yi,  a  new  white  apron  ;  others,  flour,  sugar,  molasses, 
eggs,  butter,  and  spices  with  which  to  make  cakes  and  pies ; 
and  others  of  the  younger  set  articles  of  wear,  according  to 
their  taste  and  dress  fancies. 

Whilst  the  maids  of  honor,  who  had  nodded  around  the 


SKETCH  OF  L'AJILY  IJI'i:.  43 

hearth,  waitiiij^  lh(!  (irst  .streak  oC  (layli;;lit  lo  rifle  thr-ir 
stockings  of  the  precious  promises  for  past  good  beliavior, 
were  (listribniiii!;'  tlu;  giftH  that  mad*;  (he;  reeeivers  elarnoroiis 
with  joy  and  tiuniiltuoiis  witli  tliankfuiness,  I  took  delight 
in  throwing  all  around  and  about  at  random  aim  the  lighted 
firceraekers,  thus  adding  such  consternation  to  joyous  tumult 
that  made  the  scene  seem  like  a  combination  of  paradise  and 
pandemonium,  commingling  delight  witli  uproar  in  such 
innocent  discord  that  made  the  welkin  ring  at  dawn  of 
Christmas  Day  and  filled  the  measure  of  my  fun  to  my 
heart's  content.  All  this  was  the  prelude  to  that  wider 
scope  of  enjoyment  which  made  Christmas  Day  par  excel- 
lence the  day  of  joy  and  merriment.  It  Avas  everybody's 
day  for  pastime,  fun,  frolic,  feast,  and  mutual  interchange  of 
good-will  and  bonhomie.  The  slaves  feasted  to  the  gratifica- 
tion of  their  taste  and  the  fulness  of  their  appetites.  Cato 
preferred  opossum  baked  to  his  liking,  another  roasted  pig 
flavored  with  some  favorite  herb,  but  turkey  was  the  most 
popular  flesh.  Old  Charity  added  Maryland  biscuit  and 
mince-pie  to  her  dinner  feast,  and  Yi  with  her  family  sat 
down  to  a  table  abuudantl}^  supplied  with  such  luxuries  as 
she  had  carefully  prepared  for  the  occasion.  Aunt  Hannah 
sought  surcease  in  a  glass  of  apple  toddy  made  of  red- 
streaked  apples  gathered  from  the  old  orchard  trees  on  the 
River  farm,  which  she  and  Uncle  Will  had  so  carefully 
protected  in  years  gone  by,  and  from  which  they  had  an- 
nually through  a  long  period  of  time  gathered  the  fruit. 
The  day's  festivities  concluded  with  a  shufile  hoedown  dance 
to  the  music  of  the  fiddle  and  bow  and  patting  juba,  while 
the  whole  company  united  in  singing  the  chorus  of  some 
popular  negro  melody. 

The  country  boy's  Christmas  jubilee  continued  until  the 
last  ember  of  the  back-log  ceased  to  glow.  All  his  hopes, 
anticipations,  and  preparations  were  summarized  in  the  joy 
of  the  occasion,  and  as  time  passed  on  through  the  dreary 


44  A  SOUVENIR. 

winter  months  of  the  new  year  his  recollections  of  the  inci- 
dents added  fulness  and  completeness  to  his  pleasure. 

The  winter  evenings  were  usually  very  enjoyable,  and 
most  often  passed  in  family  reunion  around  the  bright  and 
glowing  green  woodfire  in  such  chat  and  talk  as  the  current 
events  and  play-doings  might  suggest,  with  such  good  advice 
and  admonition  as  the  good  mother  might  choose  to  oifer, 
sometimes  in  warning  and  at  other  times  for  our  guidance 
and  instruction.  A  sharp  lecture,  with  cogent  expression  of 
disappointment  and  dissatisfaction,  would  occasionally  arouse 
us  from  drowsy  nodding  with  fervid  exclamations  of  "I 
didn't  mean  to  do  bad,"  and  equally  clamorous  negative 
"Won't  do  so  no  more,"  and  then  in  sober  sorrow,  quite 
often  highly  flavored  with  penitent  delight  at  escape  from 
the  spanking  slipper,  of  which  I  got  the  bigger  boy's  share 
or  all,  to  bed  to  sleep  away  both  hurt  and  penitence  as  well 
as  memory  of  good  promises  made. 

Those  less  fortunate,  who  have  not  passed  their  childhood 
and  youth  on  the  farm  in  the  days  of  woodfires  and  tallow- 
dips,  cannot  appreciate  the  primitive  and  simple  pleasures  of 
such  surroundings,  with  all  their  suggestive  and  lasting  re- 
membrances. They  cannot  realize  the  fervid  zeal  of  a  whole 
evening's  study  of  the  grim  but  radiant  visages,  some  in 
forbidding  grimace  and  others  in  less  portentous  and  more 
sightly  profile,  in  the  embers  glowing  on  the  hearth  or  hang- 
ing in  loose  bundles  to  the  burning  fagot  that  seems  just 
ready  to  part  in  the  middle  and  topple,  sound  end  down, 
over  the  heated  fire-dogs.  Nor  can  they  be  so  keenly  sensi- 
tive to  the  delight  with  which  the  rural  champion  will  watch 
and  closely  snuif  down  the  glimmering  flame  and  bet  on 
speed  of  melted  drops  of  grease  slowly  running  down  the 
uneven  surface  of  the  tallow-dip  to  collect  at  flange  of  can- 
dlestick in  flakes  of  cold  tallow.  Nor,  again,  when  rainy 
days  had  come  or  the  shingle  roof  was  covered  with 
snow,  to  watch  the  flame  bursting  from  the  chimney-tops 
from  lighted  sheafs  of  straw  pushed  into  their  throats,  to 


SKETCH  0/''  /'JAHLV  IJFK.  45 

l)iini  iliciii  oiil,  in  KiiCcty  Trom  llic  (laii^;(:r  ofKcttlii}^  the  house 
on  fire. 

.Inst  liorc"  T  must  turn  ;iAvav  Trom  siu-h  iiu-idonts  to  iiitcr- 
poUito  a  rdbroiico  to  tin;  tlirilliiiii;  (liroiiiMHlaiioo  of  rny  first 
observation  of  an  aurora-boreal  is,  now  sixty  or  more  years 
a<;'o.  It  was  a  niij^ht  with  ('ris|»  and  fast  niovinji;  wind,  and 
there  came  a  sudden  and  violent  knocking  at  tlie  door  to  call 
the  family  to  view  the  appearance  in  the  heavens,  luminous 
with  a  g;rcat  wide  stream  of  red,  with  radiatin;^,  irregular, 
and  dancing  streaks,  fading  in  color  from  base  to  point.  All 
around  and  about  the  dwelling  had  come  from  their  quarters 
the  slaves,  old  and  young,  men  and  women,  in  such  state  of 
consternation  as  boys  never  saw  before.  Some  in  dishabille, 
and  others  in  hasty  dress,  with  children  in  their  arms,  who, 
with  others,  stood  in  ghastly  terror,  with  uplifted  arms  and 
reverent  acclaim  prayed  for  protection  from  such  bloody 
carnage  and  destruction  as  their  superstitious  souls  and  de- 
throned reason  had  augured  from  the  ill-omened  phenome- 
non. Whilst  this  thrilling  scene  was  passing  I  stood  with 
throbbing  heart  and  choking  fear,  clinging  to  my  mother  in 
the  doorway,  who,  in  a  few  calmly  spoken  words,  bade  them 
go  to  their  quarters  and  rest  assured  that  no  harm  would 
come  to  them,  and,  with  that  confidence  that  comes  from  high 
esteem  and  love,  they  accepted  her  assurance  and  retired  in 
peaceful  misgiving  of  her  prophetic  words. 

The  wood-pile  at  the  farm-house  was  an  object  of  general 
interest  when  the  earth  was  covered  with  snow  and  sleet, 
the  roads  were  blocked  with  drifts,  the  streams  were  frozen 
over,  and  the  sharp  and  penetrating  wind  was  howling  under 
the  eaves.  The  choppers  Mere  busy,  and  the  carts  and 
wagons,  with  drivers  on  foot,  hurried  from  the  woods,  where 
the  axe- men  were  felling  giant  trees,  to  the  wood-pile,  where 
others  were  chopping  the  rough  and  crooked  branches  into 
shorter  or  longer  back- logs  and  other  pieces  in  length  to  suit 
the  great  and  smaller  fireplaces.  The  wood-pile  was  kept 
heaped  high  with  trunks  and  limbs  in  all  sorts  of  knotted, 


46  A  SOUVENIR. 

crooked,  straight,  roimd,  and  split  firewood,  in  irregular 
lengths  and  sizes,  with  chips  large  and  small,  thick  and 
thin,  from  bark  to  heart,  with  such  fresh  woody  odors  of 
green  wood  kinds,  gathered  in  heaps  for  kindling,  or  left  to 
sobby  in  snow  and  rain.  With  little  to  do  and  much  time 
on  hand,  it  was  our  pleasure  to  be  as  near  at  hand  and  in 
the  W'ay  as  the  swing  of  the  axe  and  flying  chips  and  slivers 
would  permit,  or,  perhaps,  climbing  up  one  side  and  down 
the  other  of  the  huge  pile  or  riding  straddle  some  project- 
ing bough  that  would  swing  up  and  down,  and  then,  with 
torn  clothes  and  many  scratches,  run  home  to  get  a  snack  of 
yeast  bread  and  sugar-house  molasses,  and  to  dry  and  warm 
the  hands  and  feet  stiffened  with  wet  and  cold.  The  w^ood- 
pile,  meal  and  flour  bins  were  objects  of  anxious  inspection 
and  inquiry  during  such  inclement  and  stormy  seasons  of 
winter's  worst  weather. 

During  such  stormy  weather  the  farm  and  public  roads 
w^ere  sometimes  so  obstructed  with  snow  and  ice,  and  in 
rainy  and  thawing  seasons  would  be  so  soft  and  deep  with 
mud,  that  hauling  and  horseback -riding  would  be  impossible. 
The  shoeing  of  oxen  was  not  in  vogue,  and  only  the  riding 
and  driving  horses  were  kept  shod.  To  avoid  the  discom- 
forts and  inconveniences  incident  to  such  conditions  it  was 
necessary  to  keep  on  hand  large  supplies  of  flour,  meal, 
wood,  and  other  but  less  important  articles  of  domestic 
necessity  which  could  only  be  obtained  from  town.  At 
such  times  long  sweetening  would  be  utilized  as  a  substitute 
for  sugar,  and  on  a  pinch  roasted  rye  could  be  mixed  with 
pure  old  Government  Java  coffee,  from  which  a  fairly  palat- 
able beverage  could  be  made.  The  meal-supply  was  sup- 
plemented with  hominy.  To  prepare  this  very  popular 
article  of  diet  and  substitute  for  bread  great  care  was  taken 
in  selecting  ears  of  corn  with  well-filled  and  flinty  grains, 
from  w4iich  the  small  and  ill-shaped  end-grains  were  sepa- 
rated by  shelling  them  separately.  The  grains  from  the 
central  portion  of  the  ear  were  then   put  into  a  wooden 


SKI'/rciI  OF  EMtl.Y  L/J'J'J.  47 

mortar  and  Ix'mIcm  with  .-m  iron  jjcslh;  imlll  broken  into 
small  pieces  and  demulcd  of  the  outer  covering,  and  then 
winnowed  to  separate  the  chaff'  from  the  broken  fragments. 
As  thus  pr('[)ai-ed  It  was  boih'd  in  an  irf)n  ])ot  until  thoroughly 
cooked,  and  stored  away  in  the  larder  for  use,  cither  warm 
or  cold,  with  milk  or  butter,  or  in  cak(!S  cither  fried  or 
baked.  Hominy  could  be  used  as  a  vegetable  or  as  a  sub- 
stitute for  bread  or  cornmcal  in  a  great  variety  of  ways, 
and  was  a  very  common  article  of  the  diet  of  a  farmer's 
family.  The  present  methods  of  preparing  small  hominy 
and  grits  by  machinery  were  unknown  at  that  time. 

The  wood-pile  was  more  often  than  the  larder  the  object 
of  anxious  solicitude.  A  half-dozen  great  fires  in  huge  fire- 
places burning  continuously  night  and  day  consumed  a  large 
quantity  of  wood.  With  a  rapidly  diminishing  supply  and 
complete  blocking  of  the  roads  and  ways  the  danger  of  a  fuel 
famine  became  very  threatening.  To  meet  such  exigencies 
hand-sleds  were  gotten  in  readiness,  to  which  ropes  were 
fastened,  by  which  the  slave  laborers  and  wood-choppers 
could  draw  enough  wood  to  keep  the  fires  going  until  the 
blizzard  subsided. 

Hog-killing  time  was  the  carnival  season  of  winter  plea- 
sure, with  its  broiled  pig-tails,  roasted  sparer ibs,  home-made 
sausage  flavored  with  garden  herbs,  crackling  Johnny  cakes 
and  fried  chitterlings.  But  these  were  the  delicious  if  not 
gluttonous  products  of  that  exciting  custom,  which  began  at 
dawn  of  day  wath  lighted  open-air  fires  to  heat  the  stones  or 
pieces  of  old  iron  to  boil  the  water  in  the  scalding-hogshead, 
in  which  to  soak  the  porkers  when  the  squeals  had  hushed 
and  blood  had  ceased  to  flow,  and  then,  with  easy  rubbing, 
clean  the  hide  of  hair,  and  hang,  head  down,  to  dry  and  cool, 
butcher  and  carve,  and  salt  away  for  boiling  with  cabbage 
and  potatoes,  for  farmer's  food  and  sustenance.  Some  may 
shudder  at  this  narrative  of  cruel  pleasure ;  but,  nevertheless, 
it  was  brimful  of  excitement  and  such  good  eatings  as  made 
country  boys  grow  fat  and  cheery.     It  was  hunkydory. 


48  A  SOUVENIR. 

The  thrifty  farmers  iu  the  neighborhood  raised  hogs  and 
cured  their  own  bacon  in  quantity  sufficient  for  their  own 
use,  with  some  to  sell.  Some  of  them  took  special  pride  in 
the  preparation  of  the  hams.  The  methods  differed  but  little, 
but  the  result  in  flavor,  color,  and  tenderness  excited  com- 
mendable rivalry  and  considerable  boasting.  Late  in  the 
fall,  after  the  corn  crop  had  been  safely  stored  in  the  crib, 
the  porkers  were  penned  and  fed  on  corn  in  the  ears,  with  an 
occasional  feed  of  cornmeal  porridge.  When  fattened  suffi- 
ciently they  were  butchered  as  before  described. 

A  smoke-house,  sometimes  called  a  "  meat-house,"  was  a 
necessary  appurtenance  of  the  farm.  It  was  usually  located 
near  the  dwelling,  and  built  of  logs  chinked  wdth  stone  and 
mud  made  of  clay  and  straw.  The  roof  was  high-pitched 
with  shingles  of  white-oak  wood.  The  roof-room  was  ar- 
ranged with  cross-pieces,  to  which  were  fastened  iron  hooks 
upon  which  the  pieces  of  bacon  were  hung  by  loops  made  of 
narrow  thin  white-oak  splints.  The  splints  were  pierced 
through  each  piece  at  some  selected  point  along  the  edge,  and 
tied  iu  a  twisted  knot.  When  the  hanging  up  was  completed 
and  the  dripping  of  brine  had  ceased  a  dull  fire  of  hickory 
wood  was  kept  burning  on  the  dirt  floor,  to  make  smoke, 
until  the  bacon  was  sufficiently  smoked.  Some  left  it  hanging 
until  each  piece  was  needed  for  cooking,  others  cut  down 
some  parts,  especially  the  hams,  and  stored  them  away  accord- 
ing to  their  methods  of  curing  bacon.  It  was  the  care  in 
butchering  and  curing  that  gave  to  the  Maryland  and  Vir- 
ginia hams  such  high  reputation.  When  I  came  to  this  city, 
and  for  many  years  afterward,  the  supply  of  Maryland  hams 
on  the  market  was  insufficient  for  the  demand.  Many  per- 
sons would  not  purchase  for  their  own  tables  any  other  kind. 
Now  it  is  difficult  to  secure  one,  except  as  a  special  favor 
from  some  farmer  who  may  continue  to  cure  his  own  bacon 
according  to  the  ancestral  method. 

Herring-catching  time,  which  occurred  annually  during 
April  and  the  early  part  of  May,  was  another  season  of 


SKh'/rcil  OF  ICAIUsY  1,1 1'E.  40 

unusual  cxcitom(!iil  jind  enjoyment.  It  vvuh  the;  custom  of 
the  farmers  to  drive  their  wagons  to  Georgetown,  where  they 
purcliased  tlio  lierriiifj:;  by  tlie  tlioiisaiid  from  the  boats  which 
brought  the  fisli  from  the;  "  fishing-landings"  down  the  Poto- 
mac, where  they  were  caught  in  seines  in  very  large  quantities ; 
and  when  the  wagons  returned  home;  everybody  that  could 
handle  a  knife  was  pressed  into  service  to  prepare  the  fish 
for  the  brine-vats,  from  whicli  they  were  in  a  few  days  taken 
and  packed  in  salt  to  remain  until  needed  for  food.  It  was 
a  common  country  saying,  how  true  I  do  not  know,  that 
fresh  herring  made  country  boys  proud  and  saucy;  but  I  do 
know  such  food  made  them  feel  good.  Herring-time  was 
fish  galore,  and  for  days,  perhaps  weeks,  the  changes  of  fish 
food  were  many :  first  broiled  fresh  herring,  then  corned 
herring  broiled,  next  fried  salt  herring,  and,  finally,  broiled 
smoked  herring,  until  one's  contentment  was  complete,  and 
saucy  pride  had  lost  its  spirit  in  digestive  ennui. 

Sheep-shearing  was  another  interesting  annual  occasion. 
It  took  place  in  June,  when  the  red  clover  and  the  roses 
were  in  bloom,  and  the  butterflies  in  myriads  crowned  the 
fragrant  flowers,  "extracting  the  liquid  sweet."  At  early 
moruing,  when  every  herb,  leaf,  and  flower  was  wet  with 
dew,  the  flock  was  driven  into  the  barnyard,  and  such  num- 
ber was  selected  as  would  occupy  the  shearers  during  the 
day.  Each  one  of  these  in  successive  order  was  caught,  tied 
to  prevent  kicking,  and  placed  upon  a  bench,  when  the 
shearers,  with  great  steel  shears,  beginning  on  the  abdomen, 
clipped  the  fleece  intact  so  closely  from  the  skin  that  one 
could  hardly  see  where  the  wool  did  grow.  The  shearing  of 
the  flock  having  been  completed,  the  wool  was  washed,  dried, 
packed,  and  sent  to  the  carding-mill,  where  it  was  made  into 
rolls  for  spinning  into  yarn,  which  was  dyed  in  such  colors, 
usually  bright,  as  were  needed,  and  then,  with  a  pattern 
mostly  in  stripes,  sent  to  the  weavers  to  be  woven  into  cloth 
for  servant's  wear.  Some  of  it  was  sent  to  the  woollen-mill  to 
be  woven  into  "  full  cloth,"  a  choicer  kind  of  cloth  than  the 

4 


50  ~  A  SOUVENIR. 

ordinary  country  material,  for  suits  and  overcoats  for  special 
wear. 

The  country  weavers  were  a  lot  of  old,  wizened  spinsters, 
as  ugly  as  a  mud  fence,  who  dressed  during  warm  weather  in 
blue-striped  cotton  home-made  material,  and  in  cold  weather 
in  gayly  striped  linsey-woolsey,  wore  shoes  down  at  the  heels, 
combed  their  hair  at  such  irregular  times  as  suited  their  con- 
venience, and  washed  their  faces  so  seldom  that  no  one  ever 
saw  them  looking  clean.  They  earned  a  meagre  livelihood 
by  plying  the  loom,  and  seemed  to  enjoy  the  life  of  work  and 
poverty.  They  all  belonged  to  one  family,  and  to  some  race 
different  from  any  known  to  the  neighborhood  people.  Some 
good  people  were  cruel  enough  to  say  they  were  a  cross  of 
the  Indian  with  the  orang-outang.  As  the  old  spinsters  had 
passed  the  age  of  fertility,  I  suppose  the  race  has  become 
extinct,  and  handloom-weaving  has  ceased  to  be  a  food- 
earning  employment.  With  the  decadency  of  such  domestic 
industries  the  spinning-wheel  has  also  disappeared  from 
common  use,  but,  strange  to  say,  it  has  become  a  drawing- 
room  ornament  to  illustrate  the  primitive  methods  of  many 
families  claiming  the  proud  distinction  of  colonial  descent. 
I  must  add,  in  this  connection,  that  my  yarn  stockings,  not 
hose,  as  now  worn,  and  long  comforts  for  wrapping  around 
the  neck,  and  ear-protectors  were  knit  of  yarn  spun  of  wool 
dyed  in  the  fleece. 

But  such  young,  sportive,  and  play-life,  with  such  "  well- 
sj)rings  of  pleasure"  and  fun  in  work  and  deviltries,  like 
true  love,  did  not  always  run  as  smoothly  in  such  boyhood 
activities  as  it  appears  in  printer's  ink.  It  had  its  ups  and 
downs,  grumpy  spells,  sullen  and  bad  temper,  and  coarser 
displays  which  might  invoke  more  lasting  inhibitory  re- 
minders. We  were  not,  in  the  parlance  of  the  present  time, 
very  bad  boys,  but  had  to  stay  indoors  and  take  the  physic 
prescribed  for  such  infractions  of  life  and  duty  as  vary  the 
life-history  of  boys  in  general,  all  the  more  often  committed 
'when  they  added  zest  and  spirit  to  pleasure  and  pastime. 


SKETCH  Oh'  K  A  III  J  Y  UFK  5] 

"  Variety  from  vvliich  frtisli  pleasures  flow"  was  not  infre- 
quently pierced  with  .sorrow.  Tlu;  K(;ttiii<^  lien  would  not 
]iivi(^li  the  eggs  ;  tin;  fuvoritf;  duckling  would  topjth;  over  and 
die  ;  the  pigwiggin  chi(!ks  wotdd  luive  the  gapes  and  die  not- 
withstanding fumigation  with  the  smoke  of  burning  tobaeco- 
stalks,  and  great,  big,  round  tears  would  roll  down  the  checks 
at  their  burial.  The  marble  thumb  would  go  wry,  the  aim 
would  miss,  and  the  other  boy  would  hold  the  keeps  or  shoot 
the  knucks.  Green  apples  and  gooseberries  would  give  the 
mulligrubs ;  and  stone-bruises  on  one  heel,  with  a  "  blood 
bile"  on  the  buttock  of  the  opposite  side,  would  keep  one 
busy  in  bed  brushing  away  the  flies  from  the  cornraeal  poul- 
tices and  sugar-aud-soap  drawing-salve,  very  much  to  the 
detriment  of  good  temper  and  peaceful  equanimity  ;  and  pain, 
griping  with  fluxes,  and  throbbing  with  "  biles,"  which 
when  squeezed  to  dislodge  the  cores  would  reach  high  up  the 
scale  of  crying  agony.  The  fish  would  not  bite,  and  the 
mullets  would  hide  in  deep  water,  and  the  storm-swept 
streams  would  swiftly  flow  with  water  too  muddy  for  swim- 
ming, and  a  ^'  fit  of  the  tantrums  "  would  finish  the  day  of 
such  lugubrious  sport.  In  brief,  disappointment  and  sorrow 
came  when  neither  expected  nor  wanted,  and  made  one  limp 
with  the  dumps  and  choky  M^th  fret,  and  roaring  and  pierc- 
ing cry  would  rend  the  air  until  the  "  timely  dew  of  sleep  " 
brought  back  dreams  of  joys  and  pleasures  new. 

Buddy  Gus,  as  my  half-brother  was  familiarly  known, 
was  an  inveterate  tease,  and  would  occasionally  provoke  my 
good  nature  to  fierce  wrath,  with  a  scrimmage  of  flying  corn- 
corbs,  wood  chips,  stones,  brickbats,  or  other  convenient 
missiles.  His  rigs,  for  the  most  part,  related  to  some  good 
turn  done  to  me  by  some  one  of  my  mother's  spinster  chums, 
either  of  the  JNIelissa  Wallace  kind,  fair,  fat,  and  forty,  joc- 
und and  round,  or  of  the  Polly  Jiugle  sort,  thin,  shrivelled, 
and  whining,  to  whose  houses  I  had  been  sent  on  some  er- 
rand, and  who  had  treated  me  with  sugar-plums  and  cakes, 
or  filled  my  pockets  with  almonds  and  raisins,  of  which  he 


52  A  SOUVENIR. 

would  rob  me  and  then  bauter  and  jeer  me  with  some  well- 
made-up  story  of  my  affectionate  regard  for  the  kind-hearted 
donor,  or,  after  having  eaten  all  my  bonbons,  would  taunt 
me  in  broad  humor  with  the  joke  that  they  were  old,  dry, 
wormy  tidbits  kept  to  give  the  nigger  boys  when  begging 
for  some  toothsome  dainty,  and  so  touch  my  pride  that  a 
fight  would  soon  follow.  But  whilst  Buddy  Gus  would  have 
his  fun  at  our  expense  he  was  never  a  talebearer,  and  we 
always  greeted  his  coming  home  from  school  and  followed 
him  in  his  long  rambles  through  the  fields,  over  the  hills,  and 
along  the  ravines,  where  his  pleasure  might  lead  him,  and  told 
him  in  free  confidence  of  our  play-doings  and  deviltries. 

After  he  left  school  and  took  charge  of  his  farm  he  was 
more  reserved  but  not  less  kind,  and  was  more  concerned  in 
my  night  lessons  than  in  my  amusements,  and  took  much 
care  to  help  me  with  my  studies.  To  his  assistance  I  owed 
much  of  my  rapid  progress. 

He  sometimes  permitted,  and  even  invited,  me  to  accom- 
pany him  on  foot  or  on  horseback  on  his  visits  to  young 
ladies,  because  I  was  very  useful  with  play  and  romp  to  de- 
coy the  small  boy  and  little  girls,  that  he  might  chat  and 
gossip  at  leisure  ease,  and  with  more  freedom,  and  make  love 
to  the  bashful  maidens  of  sweet  sixteen,  and  when,  on  ram- 
bles along  the  roads,  my  approach  came  dangerously  too 
near,  he  would  send  me  ahead  to  drive  the  cows  from  the 
roadside  or  frighten  the  shoats  from  their  v/allow  in  the 
roadway,  for  then  as  now  young  ladies  were  proverbially 
afraid  of  browsing  cows,  and  shoats,  that  awakened  from 
sound  sleep  with  a  frightful  grunt  and  startling  jump, 
scampered  away  across  the  field  with  ears  up  and  tails  twisted 
close  to  their  haunches.  Such  escapades  on  his  part  supplied 
me  with  ready  and  effective  retort,  especially  when  the 
teasing  took  place  around  the  tallow-dip  or  before  the 
blazing  family  fireside,  when  he  would  take  sudden  refuge 
in  reading  aloud  the  National  Intelligencer,  the  family  news- 
paper. 


SKETCH  OF  K  A  ILLY  IJFE.  f)'.] 

My  mother  Ixilon^cd  to  a  class  of  moflifrs  who  hflicv«l 
in  liardcniii}^  hoys  for  tho  Htruggles  of"  nKinhoo'l  life.  W'hfi) 
we  had  ^rown  (oo  hir^c  for  tin;  trtindhs-hcd  shr  hnilt  an  addi- 
tion to  the  dwelling  on  the  northern  exposure,  with  ^reat 
windows  to  let  in  light  and  sunshine,  witlu)ut  a  fireplace  or 
any  other  means  of  heating,  exee])t  witii  a  single  tallow-dij) 
at  bedtime,  or  any  convenience  for  washing  and  bathing, 
and  so  far  away  from  the  fireplaces  that  we  could  not  even 
smell  the  kindling  fires.  It  was  so,  cold  in  the  bleak  and 
freezing  winter  nights  that  my  shoes  and  yarn-knit  stockings 
would  freeze  so  hard  and  stiff  that  I  would  rush  with  bared 
feet  and  half-clad  limbs  and  body  to  the  roaring  fire  to  thaw 
them  before  saying  my  prayers  ;  then  to  the  piazza  to  break 
the  ice  in  the  tub  in  which  the  servant  had  toted  the  water 
from  the  spring,  to  obtain  the  necessary  amount  with  which 
to  wash  my  face  and  hands,  in  shivering  haste  to  return  to 
the  fire  and  turn  from  face  to  back  and  side  to  side  to  keep 
one  front  from  burning  and  another  from  freezing.  All  this 
was  in  preparation  for  the  jack-rabbit  catch,  or,  perchance, 
to  go  to  see  the  pigs  called  from  their  smoking  beds,  fed 
and  counted.  In  those  days  neither  pigs  nor  boys  were  per- 
mitted to  slumber  till  sunrise.  At  biting  daylight  the 
neighborhood  resounded  with  loud  calls  of  pigs  to  breakfast. 
Of  course,  the  early  wash  in  such  cold  comfort  was  more  for 
show  than  for  dress ;  but  at  night,  when  the  cook  was  nod- 
ding with  needle  and  patch  in  hand,  the  room  was  warm  and 
water  hot,  washing  and  bathing  could  be  completed  to  one's 
entire  and  delightful  satisfaction. 

There  may  have  been  some  merit  in  such  process  of  hard- 
ening, but  I  did  not  appreciate  it  and  have  not  been  convinced 
of  its  wisdom.     The  victims  could  not  see  the  good  of  it. 

The  time  came  when  the  joyous  and  profuse  pleasures  began 
to  fade  away.  Alfred  aud  Tom,  our  slave  companions,  a 
year  or  more  older  than  I,  had,  like  myself,  grown  old  enough 
to  assume  duties  that  furnished  employment  with  fewer  aud 
less  varied  pastimes.     However  reluctant  I  may  have  been 


54  A  SOUVENIR. 

to  give  up,  at  least  iu  a  great  measure,  my  playmates  and 
treasure  of  amusements,  the  duty  of  obedience  was  inexora- 
ble, and  to  the  country  school  for  boys  and  girls  I  had  to  go. 
Alfred  and  Tom  and  old  dog:  "  Cash  "  were  releo;ated  to  the 
fiercer  leadership  of  a  younger  brother,  who  was  just  loosen- 
ing from  the  apron-strings  under  my  tutorship,  and  for 
whose  errantry  I  was  partly  responsible,  both  by  example 
and  inducement.  It  was  well  that  it  was  so,  for  he  took 
pleasure  in  anticipating  and  making  preparation  for  my 
amusement  daring  the  afternoons  and  holidays. 

The  boyhood  companionship  of  my  brother  William  and 
myself  is  full  of  cherished  memories.  He  was  two  and  one- 
half  years  my  junior,  but  soon  became  my  equal  in  all  the 
innocent  amusements  and  deviltries  of  early  life.  With  a 
more  impulsive  temperament  and  keener  perception  he  was 
more  than  my  rival  in  many  sports  and  joys  that  made  the 
loom  of  our  lives  a  dream  of  pleasure  new.  It  goes  without 
saying  that  disagreements  and  collisions  took  place,  but  they 
w^ere  momentary,  and  perhaps  passionate  explosions  of  differ- 
ent dispositions  that  left  no  scars  to  impair  the  completeness 
of  mutual  affection.  His  country  school-life  began  just 
before  the  close  of  mine,  but  we  were  never  at  the  same 
boarding-school  at  the  same  time.  He  was  by  profession  a 
civil  engineer,  and  performed  his  first  field  service  on  a 
Virginia  railroad  as  an  assistant  in  a  corps  under  the  direc- 
tion of  the  late  General  William  Mahone.  Subsequently  he 
abandoned  his  profession  and  engaged  in  commercial  busi- 
ness in  Georgetown.  He  married  a  daughter  of  the  late 
Henry  Dunlop,  of  Frederick  County,  Maryland,  and  died 
after  years  of  ill-health  at  Aiken,  South  Carolina,  on  Feb- 
ruary 18,  1881. 

Alfred  and  Tom  were  slave-boys.  Alfred  was  the  young- 
est son  of  Charity  Martin,  the  cook,  and  was,  consequently, 
favored  with  privileges  which  the  other  slave  children  did 
not  enjoy.  Charity  Martin  had  been  my  nurse  during  my 
babyhood,  and,  to  use  her  own  expression,  "  always  had  a 


SKETCH  OF  KA  IlL  V  LIFE.  55 

warm  side  for  me/'  wliioli  J  was  quick  to  learn  and  appreci- 
ate. I  liold  lior  Micinory  in  grateful  rctnetribninf^  for  lier 
many  Bly  liivors  and  gentle  kindncjs.seH.  Alfred  wa.s  a  robust, 
round-faced,  very  black  boy,  with  a  wide  mouth,  shining 
skin,  bright  eyes,  and  a  merry  huigh,  always  ready  for  sport 
and  very  suggestive  in  play-doings.  A  dainty  tidbit  from 
the  family  table  or  a  share  of  ginger-cakes  or  any  toothsome 
bonbons  would  appeal  to  his  highest  aspiratifjns,  and  so  fdled 
him  with  willingness  and  readiness  to  contribute  to  my  pleas- 
ure and  enjoyment,  that  I  always  knew  how  best  and  most 
speedily  to  rouse  his  enthusiasm  and  startle  his  brain  with 
fresh  activities.  The  promise  of  a  share  of  my  snack  upon 
return  from  some  ramble,  escapade,  or  deviltry  would  add 
such  nimbleness  to  his  activity,  force  to  his  endurance,  and 
joy  to  his  good  nature,  that  my  promise  secured  all  the  ser- 
vice that  I  might  require.  He  was  ready  to  open  the  yard- 
gate  for  visitors,  hold  their  horses,  or  fasten  the  reins  to  the 
rack  and  receive  the  penny-tip  which  he  gave  to  his  mother. 
He  could  climb  a  cherry  tree  as  quickly  and  eat  as  many 
cherries,  with  pulp,  skin,  and  pit  altogether,  and  cry  as  loud 
with  the  "  gripes,"  as  any  other  boy.  He  was  for  a  year  or 
more  my  horse-boy,  who  rode  behind  me  to  and  from  the 
entrance-gate  of  the  orchard  farm,  and  could  stone  an  apple- 
tree  and  shake  a  peach-tree  with  marvellous  dexterity,  and 
then  gather  up  the  fallen  fruit  and  escape  while  the  farmer 
was  calling  Towser  to  sic  him  on.  In  after-life  he  was  a 
dignified  and  reputable  colored  gentleman,  and  died  several 
years  ago  in  this  city. 

Tom  was  an  awkward,  gawky,  ugly,  dark  copper- colored 
boy,  with  a  kuappy  head  and  dirty  nose,  without  emotion 
and  less  sensibility.  He  never  cared  which  end  went  fore- 
most, and  always  carried  a  stumped  toe  or  bruised  heel,  and 
could  fall  down  and  tumble  about  without  hurt  or  inconveni- 
ence. He  was  the  dray-horse  and  carried  the  basket  or  bag 
or  whatever  else  that  Mas  burdensome,  and  could  sleep  in 
the  blazing  sun  until  his  nose  and  mouth  got  so  full  of  flies 


56  ~  A  SOUVENIR. 

that  his  snoring  would  awaken  him.  He  was  obedient  and 
docile,  and  as  subservient  to  Alfred  as  to  me,  and  took  cuff- 
ing with  such  laughter  as  brought  out  his  ugliness  in  pic- 
turesque depravity.  Tom  lived  at  the  quarters  with  his 
mother,  who  was  a  voodooist  and  believed  in  "tricks"  and 
incantations.  She  would  seek  escape  from  work  because  of 
some  lameness  or  physical  disability  ascribed  to  some  "  trick" 
practised  upon  her  by  some  old  negro  whom  she  did  not  like. 
Tom  had  tricks  also,  but  of  a  different  sort,  and  he  got 
tricked,  but  in  a  different  manner.  He  cared  but  little  about 
either  the  sort  or  the  manner  in  which  he  got  tricked,  but 
took  the  world  just  as  he  found  it,  or  as  somebody  made  it 
for  him. 

Country  boys,  like  their  contemporaneous  city  boys,  some- 
times got  sick  in  those  days ;  but  sickness  was  actual  punish- 
ment, and  as  absolutely  free  from  coddling,  sentiment,  and 
sestheticism,  as  it  was  slavish  submission  to  the  tyranny  of 
primitive  medicine  and  hereditary  customs  of  domestic  sani- 
tation. It  meant  the  bed  in  a  closed  room,  with  sunlight 
and  fresh  air  shut  out,  a  feather  bed  with  heavy  blankets, 
sun-burned  water  to  drink,  and  food  of  panado,  made  by 
simmerino:  before  a  slow  fire  crumbs  of  toasted  bread  in  a 
pan  of  sun-warmed  water,  chicken-water  prepared  by  stew- 
ing the  shadow  of  some  part  of  a  chicken  hanging  by  a 
string  from  the  chimney-jamb,  or  gruel  without  salt  or  season- 
ing of  any  kind,  and  calomel  to-day  followed  to-morrow  by 
rancid  castor-oil,  or  rhubarb  sweetened  with  Santa  Cruz 
sugar,  with  nose-holding  to  enforce  its  taking.  Drinking- 
water  was  carefully  prepared  by  exposure  in  a  shallow 
vessel  to  the  hot  sun  until  it  was  as  unpalatable  and  sicken- 
ing as  the  crude  custom  could  make  it.  Burning  thirst, 
with  a  tongue  so  dry  that  a  cross  and  fretted  boy  could  not 
utter  his  discourteous  maledictions,  was  far  preferable  to 
such  potations.  Such  was  the  ordinary  regime  of  medicine, 
sanitation,  and  feeding,  to  which  were  sometimes  added  vene- 
section and  sweating-teas,  boneset  for  boys  and  tansy  for 


SKETCH  OF  I'lAIU^Y  [JFIC.  57 

^irls.  Ah  a  spcciul  favor,  at  the  retributive  sug^^cstioii  of 
soiTK!  old  woman  who  had  hiiricd  u  lialf-dozcii  fliildn-n, 
ginger  or  saHSufras  tea  waw  substituted,  cs|)ccially  in  spring, 
when  the  succulent  sassafras  was  in  bloom.  Diseases  were 
not  so  inviting  either  in  variety  or  prevalenee  as  nf)wadayH. 
Stumped  toes,  stone-bruises,  l)iles,  and  flux,  tiie  latter  espe- 
cially in  green-apple  times,  and  belly-ache  when  nuts  were 
ripening,  were  the  most  common  maladies  in  the  summer, 
and  in  autumn  seasons  sore  noses,  chapped  hands,  in  winter 
chilblains  and  choking  coughs.  Typhoid  fever  and  diph- 
theria were  not  known  then,  but  chicken-pox  and  whooping- 
cough  made  their  usual  migratory  excursions,  preparatory  to 
more  rapid  and  healthful  development.  For  nose-colds  and 
choking  coughs  "stewed  rabbit"  and  goose-oil  with  brown 
sugar  were  fiivorite  remedies.  When  the  nose-colds  did  not 
quickly  yield,  rubbing  of  the  organ  with  the  melted  drip- 
pings of  a  tallow-dip  was  very  efficacious.  Bilious  fever 
was  the  dreaded  endemic  and  invoked  the  highest  attainment 
of  medical  art  in  bleeding,  calomel-dosage,  food-attenuation, 
and  drinking-water  sun -purified ;  bleeding  at  the  elbow- 
flexures,  in  the  jugular,  and  as  a  unique  resort  at  the  ankle. 
I  am  still  alive  bearing  these  exsanguinating  scars  in  memory 
of  the  skill  and  dexterity  of  my  country  physicians,  both 
old  practitioners,  one  of  whom  was  a  graduate  and  the  other 
a  first-courser  of  the  University  of  Pennsylvania.  The  fore- 
going is  not  a  fancy  sketch,  but  the  statement  of  personal 
experience  as  I  distinctly  recall  it  to-day. 

Blood  and  blind  boils,  technically  known  as  furuncles, 
were  most  prevalent  during  the  blackberry  season,  and  were 
attributed  to  excessive  ingestion  of  the  succulent  fruit.  They 
were  considered  blood-purifiers,  aud  each  one  was  valued  at 
five  dollars.  I  would  have  willingly  sold  all  of  mine  at  a 
shilling  apiece,  with  thanks.  They  always  seemed  to  prefer 
the  parts  where  they  would  occasion  the  most  inconvenience 
and  greatest  pain ;  in  fact,  I  never  found,  except  on  some- 
body else,  a  convenient  place  to  have  one.     Stumped  toes 


58  ^  SOUVENIE. 

and  stone-bruises  were  the  necessary  results  of  barefoot 
tramping  and  stick-horse  prancing.  The  great  toes  and 
heels  were  the  usual  localities  for  such  painful  contusions. 
Barefoot  exercise  during  proper  seasons  adds  greatly  to  the 
country  boy's  enjoyment.  Tramping  through  muddy  places, 
when  the  soft  mud  will  squeeze  up  between  the  toes,  over 
the  wet  grass,  up  and  down  the  shallow  streams,  climbing 
trees,  speeding  stick-horses  on  dirt  roads,  and  chasing  butter- 
flies through  the  clover  fields  are  unknown  pleasures  to  the 
foot-geared  boy,  not  less  enjoyable  than  riding  bareback  a 
sweatino-  horse  to  water.  But  when  bedtime  came  the  old 
colored  mammy  came  around  with  tub  and  water,  soap  and 
brush,  and  rubbed  and  scrubbed  sore  toes  and  bruised  heels 
all  alike,  until  the  victim's  anger  aroused  the  grumpy  old 
"granny"  to  a  sense  of  her  cruelty. 

In  those  days  the  early  life  of  the  country  boy  on  the 
farm  was  more  widely  different  than  now  from  boy-life  in 
town.  It  was  coarser  and  more  rugged,  less  diversified,  but 
freer  from  dissipations,  more  limited  in  companionship,  with 
fewer  individual  resources,  and  totally  unaccustomed  to  the 
minor  vices  of  a  higher  and  more  luxurious  civilization. 
Tlie  country  boy  was  more  self-reliant  within  the  sphere  of 
his  mental  and  physical  opportunities,  but  less  suggestive  of 
side-issues  and  by-way  diversions ;  consequently,  his  life  was 
more  monotonous,  but  sufficiently  entertaining  for  healthy 
growth  and  development.  His  more  regular  habits,  longer 
hours  of  sleep,  fewer  perturbating  infiueuces,  more  active 
exercise  in  the  open  and  purer  atmosphere,  freedom  from 
society  and  social  excesses,  and  more  enlarged  physical  effort 
in  the  ways  of  natural  life,  and,  as  a  rule,  later  and  less 
strained  mental  discipline,  all  contributed  to  a  more  hardy 
and  robust  physique,  and  though  a  slower,  certainly  a  more 
uniform  development  of  those  qualities  of  mind  which  direct 
and  dominate  the  activities  of  manhood-life.  His  sports 
were  neither  scientific  nor  trained,  and  his  fun  and  pleasures 
were  the  outbursts  of  natural  impulses  incited  by  nature's 


SKETCH  OF  EA  III.  V  fJFh'.  59 

environments.  Ho  was  more  natural  and  less  exotic.  Habits, 
mode,  and  inciitcmcnts  of  life  formulated  liis  judj^ment,  and 
his  conclusions  and  oj)inions  were  more  intuitive  than  logical. 

With  the  beginning  of  country  school-days,  and  later 
boarding-school  conditions,  rivalries,  and  more  congenial 
and  intelligent  companionship,  with  broader  opportunities, 
soon  marked  the  lines  of  division  into  two  classes:  one 
characterized  by  sloth  and  lack  of  force,  the  other  by  energy 
and  rapid  advancement  in  mental  as  in  ;esthetic  acquirements. 
As  a  rule,  the  boy  trained  to  parental  oljedicnee  and  in  good 
morals  won  the  honors  of  class  competition.  Brilliant  pre- 
cocity was  very  rare.  Parents  did  not  seek  adoration  in 
such  illuminated  pictures  of  overstrained  brain  faculties, 
with  premature  maximum  mind  evolution,  abruptly  succeeded 
by  stupid  sloth  long  drawn  out. 

My  school-days  began  at  about  nine  years  of  age,  and  my 
wild  and  child-life  ceased,  except  on  Saturdays  and  during 
brief  holidays,  consisting  of  several  weeks  during  dog-days, 
several  days  at  Christmas,  two  at  Easter,  one  at  Whitsun- 
tide, and  the  4th  of  July.  There  were  no  legal  holidays 
nor  thanksgiving  days.  We  were  always  giving  thanks, 
and  did  not  limit  them  to  one  day  with  a  feast  of  mince-pie 
and  chicken  fixings.  I  had  been  taught  to  read,  write,  and 
cipher,  and  took  hold  of  my  new  work  with  great  avidity 
and  ambition.  The  school  began  at  9  o'clock  a.m.,  and  was 
dismissed  at  4  p.m.,  Avith  an  intermission  for  recreation  and 
luncheon  of  one  hour  at  high  noon.  For  the  first  year  or 
more  I  rode  to  and  fro  on  horseback,  with  the  old  slave 
coachman  behind  me,  who  carried  my  books,  luncheon,  and 
marbles.  The  time  consumed  on  the  road  and  in  studying 
tasks  at  home  did  not  leave  much  "  play-time,"  but  whatever 
was  left  before  supper  and  night-study  was  passed  in  some 
one  of  the  varying  pastimes  that  came  readiest  to  my  relief, 
during  which  I  would  often  crowd  in  a  whole  day  of  joy 
and  active  pleasure.  The  half  of  many  Saturdays  was 
occupied  with  riding  to  mill  on  a  bag  of  corn  and  back  on  a 


60  ^  SOUVENIR. 

bag  of  raeal,  or  in  going  on  horseback  to  town,  nine  miles 
distant,  on  errands  and  for  the  mail.  The  latter  was  an 
objectless  task,  more  irksome  than  salutary  ;  but  the  former 
afforded  an  opportunity  for  a  raid  on  somebody's  cherry- 
tree,  a  swim  in  the  mill-pond,  a  game  at  marbles,  an  occa- 
sional brawl  at  a  country  cur  dog  fight,  and,  less  often,  a 
furtive  look  at  a  cock-fight  with  steel  gaffs,  of  which  I  did 
not  make  mention  at  home.  On  the  whole,  my  mill-boy 
task  was  not  unwillingly  performed.  A  ride  for  several 
miles  and  back,  up  and  down  hill,  on  a  three-bushel  bag 
balanced  across  a  horse's  back,  was  an  accomplishment  not 
easily  acquired  by  every  country  boy,  and  the  country  grist- 
mill was  a  place  of  such  genial  neighborhood  resort  and  chat 
that  a  boy  could  hear  and  find  much  of  interest,  of  good  and 
evil  import,  preparatory  for  the  next  day  Sunday-school. 

On  my  return  from  one  of  those  errands  to  Georgetown,  I 
was  overtaken  by  Mr.  Nathan  Loughborough,  then  residing 
at  Grassland,  who  introduced  himself  to  me,  and  inquired 
if  I  was  a  son  of  John  Busey,  and  when  informed  that  I 
was,  added  that  he  thought  he  recognized  the  horse,  old  Gin, 
I  was  riding  at  the  time.  As  we  rode  along  together  chat- 
ting, he  told  me  of  his  intimacy  with  my  father  and  said 
many  pleasant  things  of  him.  When  we  reached  the  en- 
trance-gate to  Milton,  his  farm  on  the  river  road,  located 
about  two  miles  north  of  Ten nally town,  he  stopped  and 
said  that  he  wished  to  offer  me,  in  memory  of  his  admiration 
for  my  father,  a  colt  sired  by  his  favorite  stud,  the  Ace  of 
Diamonds,  which  I  accepted  with  the  delight  which  can  only 
be  appreciated  by  a  country  boy.  After  parting  I  rode  along 
hastily  home  that  I  might  tell  my  mother  of  my  good  for- 
tune, who  made  me  acknowledge  in  her  name  the  generous 
gift.  Soon  after  I  was  in  possession  of  the  colt  and  later  on 
of  a  riding  horse  in  my  own  right.  This  was  a  most  inter- 
esting incident  in  the  history  of  a  boy,  in  that  it  enabled  a 
gentleman,  through  his  recollection  of  the  horse,  to  establish 
with  the  son  of  his  deceased    friend  and   companion    the 


SKETCH  0/''  /'JARLV  LIFK  Q\ 

friendly  rol.'iti OILS  l!i;il  had,  dniiii*;  years  hciforc,  oxistfd  ])(>.- 
tween  liiinscK'  and  I  lie  (iillicr.  Mr.  Lf)ii}^lil)orouj^li  was  a 
lar^c,  ])()i-tly,  and  very  handsome;  tn:in.  Ai'icr  liis  tiiarria;^c 
with  Mrs.  Thomas,  h(!  took  up  his  rcsidcncx!  at  Milton,  and 
the  pleasant  a(;quaintanco  of  th(!  two  families  was  resumed. 

The  mixed  school  of  I)oys  and  girls  l)rou<^lit  nie  into  new 
and  closer  associations  with  the  latter  sex,  which,  I  am  quite 
sure,  exercised  a  very  happy  influence  in  restraining  the 
excesses  and  minor  vices  to  which  boys  are  so  prone.  I  have 
not  forgotten  the  rivalry  between  a  pretty  ■winsome  red- 
haired  girl  and  myself  for  head-place  in  certain  classes,  which 
taxed  my  capacity  to  the  uttermost,  and  made  the  competitive 
struggle  one  of  general  comment  and  suggestive  innuendo. 
Sometimes  one  of  us  would  deliberately  go  from  the  head  to 
the  foot  of  the  class,  that  he  might  show  how  easily  he  could 
reach  the  second  place,  and  eagerly  watch  for  the  mistake 
that  would  put  him  or  her  at  the  head  again  ;  but  our  rival- 
ries never  grew  beyond  a  lasting  friendship,  which  terminated 
with  her  death  some  years  ago.  INIy  country  school-life  con- 
tinued during  four  years  with  uninterrupted  progress,  closing 
in  a  private  selected  school  within  easy  walking  distance  of 
the  homestead,  under  the  mastership  of  quaint  old  George 
Taylor,  where,  for  the  first  time  at  school,  I  met  the  girl  of 
my  choice,  with  Avhom  was  formed  that  unbroken  mutual 
affection  which  culminated  in  forty-two  years  of  happy 
wedded  life. 

The  annual  three  Aveeks'  school  holidays,  during  dog-days, 
was  an  enforced  concession,  only  granted  by  the  schoolmaster 
when  overpowered  by  the  combined  effort  of  the  boys  and 
girls.  After  failing  in  personal  applications,  begging  solici- 
tations, and  written  petitions  to  placate  his  obdurate  inhu- 
manity, which  was  not  so  much  the  result  of  his  love  of 
conscientious  duty,  as  for  the  three  weeks'  rebate  in  tuition 
fees,  the  pupils  engaged  in  an  intrigue  to  lock  him  out,  and 
when  the  day  had  come  for  its  execution  they  assembled  in 
the  school-room,  each  one  armed  with  some  weapon  of  savage 


62  ^  SOUVENIR. 

warfare — a  broom,  sticks,  bundles  of  twigs,  bucket  of  water, 
bags  of  fine  dust,  pop  guns,  bean-shooters,  ink-squirts,  slates 
and  books,  and  such  other  pestering  missiles  as  their  inge- 
nuity and  taste  might  improvise,  securely  barred  the  doors 
and  windows  with  boards  safely  nailed  to  the  frames,  stationed 
guards  at  every  crevice  and  peep-hole  with  squirts,  dust- 
blowers,  or  pop -guns,  as  in  their  wisdom  the  committee  of 
safety  might  choose,  and  then,  when  all  was  ready,  engaged 
in  singing  a  noisy  romping  song  of  triumph  and  defiance. 
All  this  was  done  during  the  absence  of  the  master  at  luncheon 
at  some  near  farm-house.  The  pickets  along  his  route  of 
return  signalled  his  approach,  and  those  round  and  near  the 
fortress  kept  the  garrison  fully  informed  of  his  doings,  and 
warned  him  of  the  danger  of  peeping  through  the  cracks  or 
banging  at  the  barred  openings.  The  siege  was  a  period  of 
grave  concern  to  the  imprisoned  garrison,  lest  by  "  hook  or 
by  crook "  the  surly  pedagogue  should  gain  entrance  and 
force  a  fight,  hot  with  fright  and  hul-la-bal-loo ;  but  his 
impecuniosity  always  compromised  with  valor,  and  he  pleaded 
for  shorter  vacation  and  less  loss  of  pay,  which  the  committee 
sometimes  unwisely  conceded,  and  thus  the  lockout  would  be 
happily  ended,  and  the  boys  and  girls,  with  song  and  merry- 
making, would  hasten  home  to  romp  and  play  through  long 
days  of  delicious  pleasure. 

The  system  of  public  or  common  schools  had  not  then 
been  transplanted  into  Maryland  soil.  The  pride  of  ancestry 
and  nativity  did  not  tolerate  the  intrusion  of  such  Yankee 
notions.  The  country  pedagogue  was  usually  a  college 
graduate,  more  learned  than  frugal,  who  had  strolled  from 
place  to  place,  stopping  only  long  enough  at  any  one  place  to 
earn  a  precarious  livelihood,  and  then,  with  a  new  suit  of 
store  clothes  and  his  last  tuition  fees,  take  again  to  the  road 
in  search  of  some  new  field  to  flog  blockhead  and  truant 
boys  and  transfuse  simple  girls  with  good  learning. 

There  were  several  other  boys  living  at  equal  distance  from 
the  school-house,  who,  by  arrangement,  agreed  to  meet  at  the 


SKETCH  OF  KMLLY  LII'K.  6."> 

entrance-gate  of  an  ortiliaid  fiirm,  ;iii(l  llicn;  di.scljarge  our 
horses  and  foot-hoys,  to  niO(!t  us  again  in  tlif;  afternoon  at  the 
same  gate  for  exit,  that  we  might  trainj)  to  and  fro  ah^ng  the 
roads  and  pathways  through  tlie  orchard  and  under  the  trees 
laden  with  luscious  fruits  in  sucli  variety  that  even  such  good 
boys  could  not  resist  the  temjjtation  to  phick  them,  even  at 
the  risk  of  being  caught  by  the  ohl  wizen  wizard,  who,  with 
eudgel  in  her  brawny  hands,  stood  guard  from  "  early  morn 
till  dewy  eve  ;"  but  three  boys,  with  stealtli  intent  and  fleet  of 
foot,  were  not  easily  caught  or  frightened  by  the  enchanter's 
wand. 

In  those  days  the  country  school-l)oy  did  not  carry  in  his 
lunch  basket  or  satchel  fruit  from  home,  however  abundant 
on  the  farm,  because  it  bruised  and  flavored  his  bread  and 
butter,  fried  chicken,  and  long  sweetening,  nor  Avas  it  half  so 
good  as  tliat  gathered  along  the  way  from  the  hanging  boughs 
of  well-kept  orchard  trees.  The  ways  through  orchard-fields, 
though  longer  than  the  country  cross-road,  were  planted  with 
such  strong  temptations  that  distance  added  enchantment  to 
the  fascination. 

Of  the  many  episodes  none  gave  me  more  pleasure  than 
the  conventional  visits  with  my  mother  in  early  spring  and 
autumn  to  Georgetown  to  buy  summer  and  winter  clothes  for 
special  wearing  on  dress  occasions.  After  an  early  and  hasty 
breakfast,  we  would  enter  the  family  carriage,  hung  on 
C-springs,  by  climbing  up  the  unfolded  steps.  Old  Frank 
sat  on  the  front  seat  in  propria  persona,  with  high  silk  hat, 
brass-buttoned  dress  coat,  and  whip  in  hand,  and  with  old 
horse  Snap  we  jogged  away  and  along  the  road,  with  narrow 
ways,  marshy  places,  up  rough  ascents,  and  down  steep  hills, 
here  and  there  jolting  over  huge  boulders,  and  altogether 
along  just  such  a  country  road  as  made  a  country  boy  tired 
and  hungry  at  both  ends  of  the  long  journey  of  nine  miles. 
After  purchase  of  material,  with  colors  of  my  selection  and 
quality  to  my  mother's  liking,  oif  to  old  Tailor  Cam  mack 
to  have  patterns  made  by  which  to  cut  trousers  and  round- 


64  -4  SOUVENIR. 

abouts  for  the  domestic  seamstress  to  fit  and  make,  and  then, 
after  luncheon  on  cheese  and  crackers  or  candy  and  horse- 
cakes,  jog  back  again  to  home,  in  high  glee  and  brimful 
of  brag  about  my  new  clothes,  ribbon  cravats,  and  bosom 
shams.  With  wistful  pleasure,  I  watched  day  in  and  day 
out,  and  all  day  long  the  needle  and  thread  as  the  seams 
grew  longer  and  the  pieces  grew  into  shapely  clothes,  and 
wished  for  rainy  days,  that  outside  chores  might  not  call  the 
sewing-girl  from  her  work.  And,  when  all  was  done,  I 
waited  for  the  coming  Sunday  to  don  my  suit  of  newly  made 
clothes  and  show  myself  to  all  the  people  of  the  neighbor- 
hood. My  first  tailor-made  suit  came  late  in  boyhood  life, 
and  was  M^onderful  to  behold. 

I  cannot  fix  the  date  of  the  earliest  of  those  semi-annual 
visits  to  Georgetown,  but  the  vivid  recollection  of  an  inci- 
dent that  occurred  in  1835  enables  me  to  state  that  such 
visits  must  have  begun  about  or  perhaps  a  year  previous  to 
that  date.  The  roughest  part  of  the  long  journey  was  over 
the  cobble-stone  pavement  on  High,  now  Thirty-second 
Street,  which  began  at  its  intersection  with  Market,  now 
Thirty-third  Street.  At  that  date  High,  Bridge  (now  M), 
and  Water  (now  K)  Streets,  and  several  others  between  M 
and  K  Streets  were  partially  paved  with  cobble-stones,  vary- 
ing in  size  from  two  and  three  to  twenty  inches  in  diameter. 
The  surface  of  such  streets  was  so  uneven  that  no  two 
wheels  of  a  movino-  vehicle  were  ever  on  the  same  level  at 
the  same  time — so  that  our  carriage  got  a  four-cornered  jolt 
with  every  turn  of  its  M'^heels,  with  now  and  then  a  scrape 
down  the  slippery  surface  of  a  huge  boulder  into  a  sharp 
angular  crevice,  followed  by  an  upward  jog  over  the  rugged 
face  of  another  in  like  displacement.  The  acute  angular 
gutters  at  street-crossings  were  also  in  evidence  of  the  crude 
method  of  street-paving  in  vogue  at  that  early  period.  But, 
notwithstanding  such  rough  usage  of  the  carriage,  the  coun- 
try boy  was  too  much  entertained  with  the  strange  and 
changing  sights  on  the  busy  streets  to  heed  the  discomforts 


SKETCH  OF  EARLY  IJFK.  G5 

incident  thoroto.  I  fogs  and  cows  ran  at  largo  in  llio  Htrcotw. 
PTogs  w'v.Yv.  iiiiini(;i|)!il  sc;iv<Migr!rH  and  could  only  Ik;  flrivfii 
from  their  wiillow  in  tlio  filthy  streets  by  the  rough  thumb 
of  the  horse's  hoof  or  the  sharp  contact  of  the  tire  of  a  wheel. 
It  was  not  imiisnal  to  sec  a  litter  of  hungry,  squealing  pigs 
following  the  mother  sow  in  search  of  house  slops  thrown 
into  the  streets,  or  a  herd  of  railch  cows  chasing  a  load  of 
hay,  straw,  or  fodder  to  steal  a  bite  of  niii' li-nf'f]<(I  pro- 
vender. 

On  market  days  Bridge  and  High  Streets  were  more  or 
less  crowded  with  wagons  laden  with  farm  products.  Some 
were  drawn  by  oxen,  and  others  by  two,  four,  or  six  horses. 
Many  of  the  latter  were  decorated  with  hame-bells,  jingling 
out  of  tune  and  filling  the  air  with  such  "  tintinnabulum  of 
rhyme"  that  made  the  boys  whistle  in  responsive  discord 
and  pat  juba  on  the  sidewalks.  There  was  another  quite 
numerous  class  of  vehicles,  known  as  trading  or  huckster 
wagons,  that  made  weekly  or  semi-Aveekly  trips  through  the 
neighboring  counties  of  the  adjacent  States,  trading  with  the 
people  in  butter,  eggs,  poultry,  fresh  and  dried  fruits,  and 
giving  in  exchange  such  articles  of  merchandise  as  the  coim- 
try  people  might  need  or  barter  for.  Those  great  moving 
shops  were  strongly  built  with  huge  board  bodies,  roofed 
with,  canvas.  On  the  sides  were  hung  tiers  of  slat  baskets, 
crates,  and  locked  boxes  for  the  better  conveyance  of  such 
products  of  the  dairy  and  farmyards  as  could  not  be  safely 
packed  in  the  inside ;  and  always  in  his  place,  under  the 
front  axle,  the  mastiff  was  on  guard  watching  shoplifters 
and  other  intruders.  He  carried  the  danger  sign  in  his  glar- 
ing eyes  and  sullen  visage.  The  sidewalks  were  more  or  less 
crowded  with  people  of  all  ages  and  conditions  of  life,  some 
loafing  in  busy  idleness,  others  occupied  in  business  and  trad- 
ing pursuits,  many  in  objectless  haste  to  reach  some  other 
locality,  and  others  simply  to  see  and  be  seen.  The  town 
and  country  people,  as  usual,  were  easily  distinguished  by 
dress,  manner,  and  style  of  carriage. 

5 


66  ~  A  SOUVENIR. 

The  visits  to  town  were  abrupt  breaks  iu  the  life-history 
of  a  country  boy,  an'd  brought  into  sharp  and  impressive 
contrast  the  differences  between  the  routine  of  pleasure  with- 
out care  and  the  activities  of  town  and  trading  pursuits. 
The  novel  and  varying  sights  were  interesting  and  profit- 
able, and  added  much  useful  information  to  his  knowledge 
of  human  nature. 

About  this  period  two  circumstances  occurred :  the  first, 
perhaps,  a  year  earlier  than  my  first  semi-annual  visit  to 
Georgetown.  My  recollection  is  that  I  was  six  years  old, 
which  Avould  fix  the  date  of  July,  1834.  It  was  my  first 
visit  away  from  home  in  company  with  my  mother  on  a 
visit  to  her  brother,  Thomas  Clagett,  at  Weston.  While 
there  I  was  taken  sick  with  chicken-pox  and  my  mother 
hurried  home  with  me.  My  recollection  is  that  it  was  a  very 
fatiguing  journey  on  a  warm  day.  I  must  have  been  sicker 
than  children  usually  are  with  that  disease,  because  I  have 
numerous  marks  upon  my  person,  which  have  always  been 
ascribed  to  it,  but  I  have  no  recollection  of  any  suffering. 

The  other  circumstance  relates  to  a  second  visit  away  from 
home  in  company  with  my  cousin,  Ellen  Snowden,  who  was 
one  of  the  three  heirs  of  the  estate  of  our  greatuncle,  Samuel 
Busey,  to  which  I  have  previously  referred.  It  was  a  visit 
to  Count  Charles  Julius  de  Menou,  who  was  an  intimate 
friend  of  my  father,  and  after  his  death  an  occasional  visitor 
to  the  homestead. 

I  rode  behind  my  cousin,  who  was  accompanied  by  Dr. 
James  Wallace.  The  route  was  from  the  homestead  along 
the  river  road  through  Tennallytown  to  the  road,  now  known 
as  the  Pierce  Mill  road,  along  which  we  passed  the  Adlum 
vineyard,  the  old  dwelling  of  Abner  Pierce,  the  mill,  across 
Rock  Creek,  and  thence  by  the  race-course,  located  about  the 
village  of  Mt.  Pleasant,  by  a  road  to  a  farm  east  of  Seventh 
Street  road,  where  the  Count  was  then  residing.  I  cannot 
locate  the  farm.  There  is  no  record  of  his  ownership  of  any 
property  in  the  county  of  Washington  outside  of  the  limits 


SKETCH  OF  EARLY  L IFE.  f )  7 

of  the  city.  IL  may  have  l)(!on  a  tomjjorary  summer  resi- 
dence. After  rernainiii<.^  there  about  a  week  we  returned  to 
the  homestead  in  the  same  manner  as  we  had  made  our  ex- 
cursion there.  The  Count  was  at  one  time  quite  a  large 
holder  of  real  estate  in  this  city,  having  held  at  one  time 
the  property  on  IT  Street,  N.  W.,  formerly  known  as  th(! 
"chain  building,"  and  now  occupi(;d  in  })art  by  the  Epij)hany 
Church  Home.  My  visit  to  him  with  my  cousin  and  his 
visits  to  the  homestead  do  not  recall  any  incident  of  special 
interest  beyond  the  pleasant  memory  of  a  very  courteous  and 
attractive  gentleman,  who  made  himself  very  agreeable  to 
small  boys.  ThesG  circumstauccs,  like  others  I  have  nar- 
rated, illustrate  the  lasting  impression  made  upon  the  mem- 
ory by  the  intercurrent  events  of  early  life.  The  fact  of 
riding  on  horseback  behind  another  was  not  a  novelty,  nor 
did  the  way  add  interest  to  the  journey  until  it  reached  the 
intersecting  road  along  which  the  places  passed  were  new 
and  previously  unknown  to  me,  but  made  so  interesting  to 
me  by  the  description  of  our  genial  escort  and  companion, 
that  I  have  retained  a  keen  recollection  of  those  incidents  of 
the  journey.  The  farm-house  was  an  old-fashioned  one- 
story  wooden  building,  with  a  gable  roof  and  long  piazza  in 
front,  looking  out  upon  a  neatly  kept  lawn.  The  Count 
was  a  cordial  and  generous  host.  He  was  very  bald,  and 
wore  a  wig,  which  he  frequently  removed  and  put  into  his 
hat. 

At  a  later  date  I  made  another  visit  to  Georg-etown  to 
witness  a  Fourth-of-July  Sunday-school  celebration.  It  was 
the  custom  then,  and  for  many  years  afterward,  for  the  Sun- 
day-schools of  the  Protestant  congregations  to  unite  in  cele- 
brating the  Fourth  of  July.  After  weeks  of  preparation 
the  schools  assembled  at  an  early  hour  at  some  one  of  the 
churches  and  marched  thence  in  column  of  four  abreast, 
with  banners,  music,  and  other  suitable  patriotic  parapher- 
nalia, to  Parrot's  woods,  where  a  stand  had  been  erected  and 
decorated  with  flags  and  flowers.     The  grand  marshal,  with 


68  ^  SOUVENIR. 

his  adjutants  and  aids  all  on  foot,  conducted  the  procession 
in  an  orderly  manner  through  certain  streets,  previously 
designated,  along  which  on  the  sidewalks  would  gather  the 
parents  and  friends  of  the  children  to  cheer  them  with 
waving  flags,  banners,  and  handkerchiefs,  and  join  in  the 
patriotic  hurrah.  The  whole  population  turned  out  to  wit- 
ness the  pageant,  sing  praises  of  joy,  and  to  salute  the  star- 
spangled  banner.  After  assembling  at  the  woods  under  the 
old  oak  trees,  an  invocation  was  offered  by  some  one  of  the 
clergymen,  then  the  Declaration  of  Independence  was  read 
by  some  one  previously  selected  for  the  purpose,  followed  by 
an  oration,  which  concluded  the  exercises.  On  this  occasion 
the  oration  was  delivered  by  George  Washington  Parke  Custis, 
of  Arlington.  He  was  an  awkward  but  enthusiastic  speaker. 
His  whole  body  seemed  to  respond  to  his  utterances,  which 
were  delivered  with  vehemence  and  fervor.  After  the  con- 
clusion of  the  joint  celebration  the  children  dispersed  at 
pleasure,  and  the  afternoon  was  passed  in  such  gala  amuse- 
ments as  were  most  congenial. 

Other  episodes,  not  less  interesting,  but  very  different  in 
entertainment,  have  left  upon  the  memory  an  impress  quite 
as  lasting  and  vivid.  My  half-brother  was  a  Whig,  and  a 
very  enthusiastic  and  active  supporter  of  William  Henry 
Harrison  for  the  Presidency.  He  attended  all  the  cross-road 
meetings  and  '^hard  cider"  barbecues  during  the  campaign, 
occasionally  taking  me  with  him,  once  to  Rockville,  and  at 
another  time  to  Bladensburg,  where  I  joined  in  the  "  hip, 
hip,  hurrah"  for  "Old  Tip  and  Tyler,  too." 

The  barbecue  at  Bladensburg  took  place  on  the  4th  of 
July.  There  were  many  speakers,  but  I  recall  the  name  of 
but  one,  Walter  Lenox,  late  mayor  of  this  city,  who  greeted 
the  audience  with  the  salutation,  "  My  fellow-countrymen." 
This  was  so  different  from  the  usual  address  of  political  or 
stump  speakers  that  it  attracted  my  attention,  and  led  to  the 
inquiry,  which  was  answered  by  the  statement  that  he  was 
not  a  resident  of  Maryland,  but  of  the  District  of  Columbia. 


SKETCH  OF  EARLY  LIFE.  (j<) 

The  barbecue  at  Rockvillc  occurred  latfir  during  the  cam- 
paign, perhaps  during  th(;  holiday  season  of  tlic  araderay, 
because  it  was  hehl  witliin  tlic  in(!losure  of  tliat  institution. 
It  was  a  much  hirger  and  more  enthusiastic  assemblage,  in- 
chiding  many  ladies.  Two  log  cabins  had  been  erected,  in 
which  numerous  barrels  of  cider  had  been  placed,  from 
which  the  beverage  was  dispensed  in  glasses  and  mugs, 
through  open  windows,  to  every  person  in  such  number  of 
glasses  as  each  might  choose  to  ask.  The  supply  seemed  to 
be  inexhaustible,  and  was  drank  ad  libitum.  Toward  the 
close  of  the  day  the  enthusiasm  became  very  pronounced 
and  boisterous,  to  which  the  glee  club,  with  its  campaign 
melodies,  added  an  entertaining  merriment.  On  this  occa- 
sion I  heard,  for  the  first  time,  the  late  Reverdy  Johnson 
and  Joseph  H.  Bradley,  Sr.  The  latter  I  had  known  pre- 
viously, and  was  especially  impressed  by  his  description  of 
the  late  Francis  P.  Blair,  whom  he  characterized  as  the 
ugliest  man  on  the  face  of  the  globe. 

Some  time  during  the  same  campaign  I  attended  a  Har- 
rison and  Tyler  meeting  at  Georgetown.  It  was  held  in 
Parrot's  AVoods,  now  the  Oak  Hill  Cemetery.  Governor 
Call,  of  Florida,  was  the  leading  orator  on  that  occasion, 
and  impressed  me  as  a  very  handsome  man  and  a  fluent  and 
graceful  speaker.  He  had  lost  an  arm — I  think  the  left — 
the  stump  of  which  he  would  touch  with  his  right  forefinger 
whenever  he  sought  to  make  a  very  impressive  gesture.  My 
recollections  of  these  events  seem  to  be  indissolubly  asso- 
ciated with  the  apparently  trivial  incidents  relating  to  the 
salutation  of  Lenox,  the  ugliness  of  Blair,  and  the  gesture 
of  Call. 

As  the  day  for  the  inauguration  approached  my  brother  quite 
often  asserted  his  intention  to  attend,  and  finally,  after  much 
begging  on  my  part,  consented  to  allow  me  to  accompany 
him  to  witness  the  imposing  ceremonies,  March,  1841.  On 
the  morning  of  that  day  we  made  an  early  start,  I  riding  by 
his  side  on  old  Gin  to  Georgetown,  and  then  walking  along 


70  ^  SOUVENIR. 

Pennsylvania  Avenue,  watching  with  gaze  and  astonishment 
the  President  on  horseback,  with  bared  head,  and  the  great 
procession  of  men,  soldiers,  carriages,  and  platform-wagons 
laden  with  machines,  to  the  east  front  of  the  Capitol,  where 
I  heard  the  inaugural  address  and  saw  the  President  of  the 
United  States  take  the  oath  of  office.  Then  back  to  the 
White  House  with  the  dense  crowd  on  the  street,  and 
"  piggy-back "  through  the  denser  crowd  at  the  Executive 
Mansion  to  shake  hands  with  President  Harrison.  It  was 
my  first  sight  of  a  great  procession  of  soldiers  with  dazzling 
uniforms,  glittering  sabres,  burnished  guns  and  waving 
plumes,  some  on  horseback,  many  on  foot,  and  others  riding 
gun-carriages  and  caissons,  with  men  decked  with  badges, 
ril3bons,  and  streaming  sashes,  bearing  banners,  flags,  and 
ludicrous  caricatures,  followed  by  a  long  train  of  vehicles, 
and  many  wagons  with  four  and  six  horses  dragging  indus- 
trial machines,  some  in  operation  turning  out  the  manufac- 
tured articles,  which  were  thrown  to  the  gaping  and  bellowing 
crowd  pressing  close  to  the  beasts  and  under  the  wheels.  All 
this,  with  drum  and  fife,  bands  of  music  with  great  shining 
brass  instruments,  and  "  glee  clubs  "  singing  "  Tip  and  Tyler 
too"  and  '^hard  cider"  melodies,  and  others  roaring  out  the 
partisan  slogan,  "Roast  beef  and  two  dollars  a  day,"  such 
as  a  country  boy  never  saw  or  heard  before.  What  would 
life  at  sixty-eight  be  without  such  a  recollection  ?  I  have 
seen  many  similar  processions  since,  but  none  seems  to  have 
been  as  large,  none  so  brilliant  and  impressive.  Thrilled 
with  wonderment,  filled  with  the  vastness  of  things  all  new 
to  me,  and  amazed  at  sights  never  before  heard  spoken  of, 
I  tramped  back  to  old  Gin  and  the  saddle,  and  rode  along 
the  lonely  road  home  in  profound  silence,  but  with  that 
pride  and  satisfaction  that  seemed  to  lift  me  far  above  the 
level  of  the  crude  and  awkward  rural  champion. 

Not  long  afterward  I  came  again  to  the  city,  but  then  to 
see  a  procession  with  flags  furled  and  banners  draped  in 
mourning,  marching  in  solemn  slowness  to  the  funeral  dirge, 


SKETCH  OF  FA  III,)'  LIFE.  ^\ 

in  sorrow  for  tlic  cJiiciftain  vvlioni  Ji  fdw  wcoUh  bcfon;   I    had 
seen  ride  in  triurajili  to  the  (!aj)il()h 

And  a,<;ain,  a  ycai"  lafcr,  in  coinpany  witli  Tlicihard  Williams, 
a  near  neighbor  and  friend  of  my  niother,  I  rarne  to  Hee  Con- 
gress in  session,  and  for  the  first  tini(!  to  look  down  frf)ni 
the  galleries  n))on  the  assembled  wisdom  of  the  iS'ation,  of 
whieh  1  iiad  heard  so  ranch.  I  saw  members,  some  in  loose 
blonses,  others  in  trig  attire,  walking  all  abont  in  noisy 
familiarity.  I  watched  the  Speaker's  gavel  calling  to  order, 
and  men  all  abont  the  hall  jumping  up  and  calling  out  to 
catch  the  Speaker's  eye,  and  saw  the  pages  chasing  the  loud 
calls  and  sharp  raps  of  impatient  members.  The  clerk 
would  read  a  few  words,  and  then  again  from  all  parts  of 
the  echoing  hall  would  come  the  emphasized  and  redupli- 
cated resounding  call — "  Mr.  Speaker,"  as  if  every  man  was 
full  of  fight  and  only  waiting  for  some  one  to  knock  the 
chip  off  his  shoulder.  It  was  so  different  from  the  solemn 
church  services,  where  one  man  did  all  the  talking,  to  which 
I  had  become  accustomed,  that  I  was  not  anxious  to  come 
asrain  soon.  In  the  Senate  chamber  I  felt  as  if  I  had  been 
suddenly  transported  back  to  Bethesda  and  was  in  the  sol- 
emn presence  of  old  Dr.  John  Mines,  listening  to  some 
awful  story  of  hell-fire  and  hot-lead  poisoning ;  but  imagine 
my  awe  when  I  was  ushered  on  tip-toe  into  the  gloomy  vault, 
under  the  present  chamber,  of  the  Supreme  Court  and  beheld 
the  old  gray-haired  and  bald-headed  judges  robed  in  gowns 
as  black  as  first-class  mourning  dresses.  I  stored  away  lots  of 
experience  and  history  during  that  one  day,  and  grew  so 
bold  and  proud  with  imitative  eloquence  that  Buddy  Gus 
felt  it  to  be  his  duty  to  check  the  progress  of  my  parlia- 
mentary aspirations  by  such  ridicule  and  mimicry  as  his  ready 
wit  might  offer. 

Dancing  was  no  part  of  my  early  education.  Presby- 
terianism  and  jNIethodism  were  too  rife  among  the  goodly 
people  to  tolerate  such  giddy  but  rhythmic  grace  of  move- 
ment and  joy  of  youth  and  maiden.     ^ly  mother  was  not 


72  ^  SOUVENIR. 

averse  to  it,  but  the  neighborhood  proprieties  would  have 
been  shocked  at  such  assemblages  of  boys  and  girls.  On  one 
occasion  I  was  permitted  to  accompany  my  half-brother  to  a 
large  wedding,  and  there  for  the  first  and  only  time  during 
boyhood  life  saw  ladies  and  gentlemen  engaged  in  dancing. 
I  believe  the  neighborhood  restraint  was  somewhat  relaxed 
after  I  left  the  country,  in  1845,  and  the  young  people  did 
occasionally  steal  an  opportunity  and  dance  in  defiance  of 
the  censorship  of  the  matrons  and  more  austere  spinsters  who . 
had  never  enjoyed  the  fascinating  pleasure.  In  fact,  except 
on  the  occasion  referred  to,  I  never  saw  any  dancing  until  I 
came  to  this  city  to  live,  in  1848. 

The  reader  will,  therefore,  not  be  surprised  that  my  re- 
sources of  pleasure  and  pastime  were  limited  to  the  intuitive 
devices  and  inclinations  of  farm  life  and  to  the  primitive 
habits  and  customs  of  a  country  neighborhood  and  exclu- 
sively rural  society.  But,  notwithstanding  the  absence  of 
and  aversion  to  some  of  the  gayeties  common  to  most  coun- 
try neighborhoods,  even  in  those  days,  the  routine  of  life  was 
sufficiently  diversified  to  be  very  attractive,  especially  so  to 
the  boy  who  was  free  to  indulge  his  fancies  and  inclinations 
and  could  command  at  will  the  assistance  of  and  direct  others 
in  subordination  to  his  own  proposals. 

With  the  beginning  of  the  autumn  session  (1841)  of  the 
Rockville  Academy  I  bade  farewell  to  those  joys,  deviltries, 
and  pastimes  that  had  greeted  the  younger  life  with  so  much 
pleasure ;  and  there  began,  with  other  companions  and  fresh 
rivalries,  the  struggle  with  the  problems  of  a  higher  curric- 
ulum, where  gratification  came  only  through  the  higher 
marks  of  success  and  proficiency.  The  study-room  was  the 
only  playground,  and  the  class  recitation  the  only  field  sport. 
Perhaps  I  can  better  tell  the  story  of  my  life  at  the  Academy 
by  narration  of  the  following  events  :  Joseph  H.  Braddock, 
a  man  of  great  learning  and  principal  of  the  classical  de- 
partment, died  early  in  September,  1843,  and  the  students 
in  that  department  were  left  without  a  teacher  until  his 


SKETCH  OF  KAHI.Y  LIFh'.  7;> 

successor,  Otis  ('.  Wight,  now  of"  this  city,  wan  olcrtcd  latf! 
in  November.  Immediately  after  the  death  of  the  principal 
the  stiidents  rcniaininjr  in  tlu;  village,  nine  in  nuriihcr,  or- 
ganized into  a  cla.ss  and  elected  the  senior,  William  8.  Grafl", 
to  the  tutorship,  to  whom  all  recitations  were  made  as  regu- 
larly and  ])ronii)tly  as  to  the  de(!eased  principal.  The  Hoard 
of  Trustees  of  the  Aeadcsmy  at  that  time  was  constituted, 
with  others,  of  John  Mines,  D.D.,  a  distinguished  divine  of 
the  Presbyterian  denomination  ;  E.  Erving  Gillis,  D.D., 
afterward  rector  of  Ascension  Parish  in  this  city;  Richard 
John  Bowie,  late  Chief  Justice  of  the  Court  of  Appeals  of 
Maryland,  and  John  Brewer,  a  distinguished  attorney  at 
the  local  bar.  All  the  applicants  for  the  vacancy  failed  at 
the  first  examination,  and  the  advertisment  for  applications 
was  renewed.  A  day  or  two  afterward  Mr.  Wight  reached 
the  village,  and,  being  informed  of  the  failure  to  fill  the 
vacancy,  determined  to  wait  until  the  second  examination. 
In  the  meantime,  by  request,  he  assumed  the  tutorship  of 
the  class  of  nine,  and  on  the  day  of  examination  of  appli- 
cants that  class  of  boys  voluntarily  uuited  in  a  petition  to 
the  Board  of  Trustees  in  favor  of  the  election  of  Mr.  Otis 
C.  Wight  to  the  vacancy.  I  do  not  know  how  much,  if  any, 
the  recommendation  influenced  the  Board,  but  he  was,  to  our 
great  satisfaction,  selected.  I  may  be  excused  for  concluding 
this  narrative  with  the  following  letter  from  this  venerable 
and  honored  man  : 

306  Indiana  Avenue,  October  14,  1895. 
"Dear  Dr.  Busey: 

"I  have  received,  through  the  hands  of  John,  a  copy  of  your  Per- 
sonal Reminiscences,  for  which  please  accept  my  thanks.  I  have 
already  been  much  interested  in  some  portions  of  the  book,  and  am 
anticipating  pleasure  in  further  perusal.  But  I  am  especially  grati- 
fied in  being  thus  remembered  by  one  of  the  first  pupils  at  the 
Rockville  Academy — one  of  the  nine  in  the  classical  department.  I 
often  think  of  those  days,  just  fifty-two  years  ago.  I  had  been  out  of 
college  one  year  and  had  launched  my  boat  on  the  sea  of  life,  almost 
as  uncertain  where  I  should  cast  anchor  as  the  patriarch  Abraham 


74  A  SOUVENIR. 

was  when  he  left  home.  I  am  a  firm  believer  in  the  leading  and 
guiding  hand  of  my  Heavenly  Father,  and  I  thank  him  for  leading 
me  to  Rockville,  a  place  which  I  knew  not  of  ten  or  twelve  days  be- 
fore I  commenced  teaching  the  '  nine.'  I  have  kept  them  all  in 
interested  remembrance  and  watched  their  progress.  I  sincerely 
congratulate  you  for  what  you  have  accomplished,  for  the  distinction 
you  have  achieved,  not  only  in  practice  professional,  but  for  your 
numerous  contributions  to  medical  literature. 

"  Most  truly  your  friend, 

"0.  C.  Wight." 

During  my  residence  at  Rockville  I  lived  with  one  of  two 
private  families — during  the  first  year  with  the  family  of 
Thomas  F.  Vinson,  and  afterward  with  that  of  John  Brewer. 
My  mother  was  averse  to  boarding-house  life,  where  I  could 
have  had  the  companionship  of  school  friends  and  class- 
mates during  out-of-school  hours.  My  pleasures  and  pas- 
times were,  therefore,  limited  and  mainly  restricted  to  my 
own  resources,  which  consisted  for  the  most  part  in  study 
and  reading,  with  an  occasional  ramble,  most  often  alone, 
but  sometimes  with  some  chum  with  whom  I  had  made  a 
special  engagement  to  go  swimming,  fruit-hunting,  nut- 
gathering,  or  for  some  other  mutually  agreeable  recreation. 
On  one  occasion,  made  memorable  by  certain  incidents,  I 
occupied  the  greater  part  of  an  off-day  in  gathering  chest- 
nuts for  my  winter  supply.  After  strolling  for  some  time 
through  unknown  forests  and  fields,  I  discovered  in  an  open 
field  a  very  large  chestnut  tree  with  wide-spreading  branches 
filled  with  open  hulls  ready  for  the  thrashing-pole.  I 
climbed  to  its  upper  branches,  and  as  I  descended  thrashed 
every  branch  until  I  thought  I  had  stripped  it  of  every  ripe 
nut ;  then  gathered  them  into  my  bag,  and  trudged  back 
home  with  the  product  of  my  half  day's  hard  work,  for 
which  I  was  complimented  by  Mr.  and  Mrs.  Brewer.  A 
few  days  after  one  of  two  maiden  ladies,  who  was  notorious 
for  her  boisterous  dislike  of  mischievous  boys,  dined  with 
the  family,  and  Avhile  at  the  table  opened  fire  with  volley 
after  volley  of  just  such  words  as  made  me  wince  in  silent 


SKf'JTCir  OF  EAItl^Y  LII'K.  75 

and  unite  (lespcnitioii,  lest  I  iiii^lit  in  Honic  munnor  exiiihit 
some  sign  of  guilt  that  would  provoke  her  anger  beyond  the 
vehement  utterance  of  euss  words.  Mr.  and  Mrs.  Ji.  very- 
soon  connocited  nu;  with  the  oirence,  and  very  adroitly  as- 
sisted me  in  escaping  detection.  Miss  Belle  never  discovered 
the  offender,  and  I  never  again  invaded  her  premises. 

As  a  matter  of  personal  history  another  incident  may  be 
worthy  of  record.  Attracted  by  the  apparent  pleasure  and 
consolation  which  the  village  smokers,  as  they  loafed  about 
the  streets,  seemed  to  derive,  I  reasoned  myself  into  the 
belief  that  I  might  find  company  and  comfort  in  the  vice. 
On  a  single  occasion,  on  my  way  along  the  street  to  my 
home  on  the  outskirts  of  the  village,  I  bought  at  a  grocery 
store  a  cigar  of  the  Principe  brand,  put  it  safely  into  my 
pocket,  and  walked  along  leisurely  homeward  in  lonely  con- 
templation of  the  pleasure  to  come.  Late  in  the  afternoon, 
after  I  had  completed  my  study  task,  I  strolled  into  the 
peach  orchard  to  gratify  a  gluttonous  appetite  with  the 
ripened  fruit,  and  when  fully  satisfied  sat  down  on  the  grass 
under  a  tree  in  peaceful  contentment,  lighted  my  cigar  and 
puffed  away  great  mouthsful  of  smoke  that  curled  upward 
through  the  leaves  of  the  overhanging  branches  of  the  tree. 
Every  boy  with  such  early  experience  knows  full  well  what 
followed.  The  half-consumed  cigar  soon  dropped  from  the 
finger's  grasp,  my  head  began  to  whirl,  sight  grew  dim  and 
dimmer,  with  visions  of  indescribable  forms  floating  near  and 
far  in  the  circumambient  space,  like  spectres  in  "  confusion 
worse  confounded,"  languor  was  followed  by  such  relaxation 
that  I  lay  so  prostrate  upon  the  greensward  that  I  could  not 
roll  from  side  to  side  in  the  agony  that  came  with  the  mouth 
gaping  so  wide  that  the  joints  of  my  lower  jaws  would  creak 
with  strain,  the  tongue  would  protrude  with  such  force 
against  the  lower  incisors  as  seemed  would  cut  it  crosswise, 
and  the  upheaving  straining  of  a  stomach  filled  to  repletion 
added  torture  to  the  anguish  of  my  suffering.  I  need  hardly 
add  that  I  was  late  at  supper  and  early  to  bed  that  evening. 


76  A  SOUVENIR. 

Several  decades  passed  before  I  again  tested  the  flavor  of  a 
Principe,  but  now  I  am  not  unlike  the  village  loafer,  seeking 
pleasure  and  consolation  in  the  vice  of  smoking. 

With  such  exceptions  my  life  at  Rockville  was  uneventful, 
with  a  weekly  visit  home,  which  for  the  most  part  was  passed 
in  idle  recreation  with  the  family,  and  a  visit  to  Springfield, 
the  homestead  of  the  Posey  family,  to  keep  up  and  foster 
my  acquaintance  with  the  girl  to  whom  I  have  before  re- 
ferred, until  she,  like  myself,  was  sent  away  to  boarding- 
school,  the  circumstance  which,  perhaps,  had  more  influence 
than  any  incident  of  my  life  in  determining  my  course  of 
conduct  in  after-life.  I  lived  then  to  win  her  love,  as  I  lived 
long  afterward  to  make  her  happy  and  comfortable.  There 
were  pretty  girls  at  Rockville,  but  I  was  callous  to  their  be- 
witching charms,  "  for  never  was  one  more  blind  to  beauty 
that  hangs  upon  the  cheeks." 

My  sly  visits  on  Saturdays  to  Springfield  were  not  always 
free  from  perturbating  incidents  that  sharpened  the  ragged 
edges  of  disappointment  and  pierced  my  hopes  with  discon- 
solate misgivings.  Miss  Catharine  had  younger  sisters, 
especially  one  just  at  the  age  when  little  sisters  will  hang 
around,  catch  bits  of  conversation,  and  take  pleasure  in  tell- 
ing tales  out  of  school.  I  was  not  afraid  of  her  gossipy  and 
tattling  tongue,  for  I  was  too  shy  and  timid  to  tell  the  story 
of  my  love,  and  kept  as  far  away  from  the  real  object  of  my 
visits  as  a  bashful  youth  tries,  but  usually  fails,  to  do.  The 
fascinations  of  a  pretty  girl,  with  winsome  ways  and  not 
altogether  free  from  coquettish  pranks,  are  a  little  too  much 
for  the  country  youth  whose  bashfulness  is  tlie  measure  of 
his  infatuation.  On  such  occasions  the  little  sister,  with  coy 
reluctance,  would  whisper,  in  sentences  broken  by  pert  side 
glances  and  smothered  exaltation,  into  my  wistful  ears  stories 
of  the  frequent  visits  of  rival  suitors,  whose  opportunities 
were  so  much  more  favorable  than  mine,  that  sank  so  deep 
into  my  heart  as  sometimes  to  hasten  the  good-bye  and  a 
petulant  departure,  to  return  along  the  lonely  road  to  Stony 


SKETCH  0  F  KA  R  L  V  L  FFK  7  7 

Lonesome,  and  there  to  drain  (In-  cup  of  j)oii(  .-uid  lieavy- 
he;irt(;dnos.s  in  ixu>ck  iii(!rriin('iit  and  iMH)rovi.sod  ^ood  rlicer. 
But,  witli  iVcsli  (•(mnigr,  the  succ-ecding  .Saturday  found  me 
on  the  road  to  repeat  my  visit,  and  tlie  greeting  of  i\u-.  little 
sister,  perhaps  at  the  entrance  gate,  where  slie  was  wont  to 
watch,  witli  the  welcome  salutation  that  sister  Kitty  was 
waiting  my  arrival,  was  sufficiently  significant  to  inspire 
even  such  a  diffident  lover  with  hope,  and  encourage  him  to 
accept  the  innocent  pranks  of  a  girl's  affection  with  less 
trepidation. 

I  do  not  know  how  much  the  chatty  sister  may  have  teased 
my  rivals  with  newsy  tales  of  myself,  for  they  were  older 
than  T,  and  looked  upon  me  as  a  lovesick  youth  whose 
infatuation  would  attenuate  with  delay ;  but  she  was  my 
good  friend,  and  seemed  to  play  the  part  of  an  avaunt- 
Gourier,  bearing  peace-offerings,  wath  bits  of  information  that 
served,  at  least,  to  lighten  the  burden  of  distrust  and  hold 
out  a  ray  of  hope.  Like  one  drowning,  I  caught  at  every 
straw,  and  drank  in  deeply  the  friendly  prattle.  I  was  even 
more  ready  to  accept  trivial  signs  of  favor  than  quick  to 
pout  with  the  dumps.  And  so  the  boyhood  courtship  ran  its 
course  of  miseries  and  pleasures  through  several  weary  years, 
with  gradually  increasing  confidence,  before  I  could  screw  my 
courage  up  to  the  sticking-point  "to  tell  the  story  of  my  timid 
homage,"  and  bear  away  "the  chief  of  all  love's  joys" — "  the 
breath  of  a  maiden's  yes." 

This  event  came  to  pass  during  the  early  autumn  of  1845, 
after  I  had  commenced  the  study  of  medicine  in  the  office  of 
Doctor  Hazekiah  ISIagruder,  in  Georgetown,  and  the  young 
lady  had  finished  her  course  of  studies  at  the  seminary  in  the 
same  city,  kept  by  Miss  English,  and  each  of  us  was  freed 
from  the  discipline  of  boarding-schools,  which  had  limited 
our  interviews  to  Saturdays.  I  was  then  at  liberty  to  make 
my  visits  at  my  pleasure  and  her  convenience.  Previously 
I  had  chosen  Saturday  because  both  of  us  were  at  our  country 
homes  on  that  day,  and  I  was  not  so  likely  to  be  embarrassed 


78  ~  -4  SOUVENIR. 

by  the  intrusion  of  other  visitors.  During  the  succeeding  six 
or  eight  months  our  affianced  lives  ran  their  course  in  smooth- 
ness until  broken  bv  my  departure  for  Philadelphia  to  enter 
the  private  office  of  Prof.  George  B.  Wood,  and  to  matricu- 
late in  the  University  of  Pennsylvania,  from  which  I  grad- 
uated on  April  8, 1848.  During  my  residence  in  Philadelphia 
I  made  but  one  visit  home,  during  which  I  was  a  daily  visitor 
at  Springfield.  The  photogravure  picture  marked  1848  is  a 
reproduction  of  a  daguerrotype  taken  a  few  days  before  my 
graduation. 

In  those  days  engaged  people  did  not  rush  into  the  public 
press  to  announce  it.  The  engagement  was  held  as  an  invio- 
lable secret,  not  to  be  communicated  outside  of  the  immediate 
families  of  the  affianced  couple  until  the  wedding-day  was 
fixed.  Of  course,  in  a  country  neighborhood,  gossipy  innu- 
endo and  suggestion  kept  up  a  continuous  discussion  of  an 
affair  M^hich  everybody  believed,  but  no  one  knew  to  be 
true.  Immediately  after  graduation  in  medicine  I  settled 
in  this  city,  and  was  married  on  the  first  day  of  May, 
1849. 

As  I  have,  in  the  foregoing  pages,  referred  to  the  slave 
environments  of  my  early  life,  it  may  not  be  inappropriate 
to  supplement  those  allusions  with  some  more  general  state- 
ment of  such  surroundings  as  I  saw  them  at  that  early  date. 
Whilst  the  general  and  enforced  manumission  of  slaves  must 
have  convinced  every  reflecting  person  of  the  evils  of  slavery 
in  general,  and  more  especially  of  the  adverse  influences  of 
slave-labor,  so  obstructive  to  the  progress  of  a  higher  civili- 
zation, my  young  experience  leaves  no  impression  of  those 
wrono:s  and  cruelties  of  which  I  have  heard  and  read  so 
much  in  later  years.  There  were  not  many  slaves  in  the 
neighborhood,  but  nearly  every  farm  was  cultivated  in  whole 
or  in  part  by  slaves,  in  some  cases  led  in  the  field  by  the 
owner  or  grown  sons,  with  hired  white  labor,  between  whom 
and  the  slaves  there  were  no  labor  distinctions.  In  the  harvest 
and  mowing  fields  the  best  cradler  and  most  expert  scythe- 


SKETCH  OF  EARL  Y  IJFE.  79 

man,  white  or  black,  woiiM  \n\  uwjinlcd  iIk;  loadorshij),  arifl 
the  lafijgard  AjII  to  tlu;  rear. 

They  were,  with  rare  exeeptions,  an  onh;rly,  f^iiiet,  wfil- 
behaved,  church-goirif^  people,  usually  attendini^  the  master's 
church.  All  had  their  fi^o-to-mcetiu}^  ch)the.s,  the  women 
with  red  or  striped  turbans,  a  neat,  if"  not  tasteful,  head- 
gear, and  other  dress-wear,  if  not  to  match,  quite  as  pleasing 
to  their  taste.  Every  slave  family  had  its  farm  perquisites, 
in  the  way  of  allowances  for  free  and  over-time,  rabbit  and 
partridge  trapping,  nut-gathering,  fruit-drying,  garden  truck, 
and,  occasionally,  a  pig  to  feed  and  butcher  for  barter,  and 
small  money  donations,  with  off  Saturdays  to  go  to  town  to 
barter  and  buy.  They  were  cheerful,  if  not  the  most  indus- 
trious laborers.  Negroes,  like  most  white  people,  love  labor 
best  with  least  hard  work,  and  if  not  frugal  in  their  methods, 
they  accomplish  their  work-tasks  without  detriment  to  their 
physical  being.  Surely  my  association  with  and  youthful 
observations  of  the  negro  slaves  during  my  country  and 
farm  life  occasion  me  no  regret.  They  treated  me  with 
kindness,  gentleness,  and,  perhaps,  too  much  forbearance, 
and  the  "  mndders"  were  more  ready  with  rod  and  switch  to 
punish  my  companion-playmates  than  those  who  were  better 
judges  of  my  aggressive  spirit.  I  do  not  claim  this  picture 
of  contentment  and  happiness  was  free  from  blemishes,  but 
they  were  only  such  as  served  to  bring  out  the  finished  parts 
in  more  vivid  contrast  and  make  a  more  enduring  impression. 

To  conclude  this  sketch  without  a  final  reference  to  the 
wife  of  forty-two  years  of  a  happy  life  would  prove  me 
recreant  to  the  finer  feelings  of  honor  and  affection.  Xot 
one  day  has  passed  since  her  death,  January  26, 1891,  that  I 
have  failed  to  recall  the  charming  recollections  of  her  sweet 
and  lovely  disposition,  and  to-day  I  cherish  her  memory  with 
the  same  pride  and  ardor  as  when  the  two  young  hearts  were 
made  one.  To  those  who  kncAv  her  no  eulogium  is  necessary 
to  revive  and  intensify  their  admiration,  nor  can  I  offend  the 
precious  memories  of  her  life  by  any  attempt  to  pictm-e  her 


80  ^  SOUVENIR. 

pure  life  by  the  measure  of  my  affectionate  regard  and 
devotion ;  but  I  write  of  her  as  others  knew  her.  Her 
Christian  purity  remains  to-day  untarnished  by  one  thought 
or  spoken  word  of  evil  of  any  human  being.  Her  kindly 
and  equitable  temperament,  mellowed  and  strengthened  by 
genuine  friendship,  high  integrity,  benevolence,  and  Christian 
faith  added  beauty  and  simplicity  to  a  character  so  blessed 
with  the  saintly  qualities  of  mind  and  heart  that  none  knew 
her  but  to  love  her,  and  the  better  she  was  known  the  more 
she  was  loved.     I  forbear  to  add  another  word. 


MISCELLANEOUS  ESSAYS 


AK-D 


ADDRESSES. 


MEDICAL  ASSOCIATION  OF  THE  DISTRICT  OF 
COLUMBIA. 

ADDRESS   BEFORE   THE  MEDICAL  ASSOCIATION  OF  THE  DIS- 
TRICT  OF   COLUMBIA,   ON  A    RESOLUTION   TO   REVISE 
ITS  CODE  OF  ETHICS  AND  REGULATIONS, 
DELIVERED   MAY,  1874. 

In  support  of  his  motion  Dr.  Busey  said  he  had  offered 
the  resohition  believing  the  time  had  come  when  the  Asso- 
ciation should  be  reorganized.  Its  Code  of  Ethics  and  reg- 
ulations should  be  revised  and  made  to  conform  to  the 
Code  of  Ethics  of  the  American  Medical  Association.  As 
this  body,  to  qualify  its  delegates  to  the  national  organization, 
was  compelled  to  adopt  the  Code  of  Ethics  of  that  body,  and 
every  delegate  presenting  his  credentials  was  required  to  sign 
it,  it  was  manifest  that  no  local  provision  or  regulation  antag- 
onistic to  the  general  code  could  be  binding. 

The  code  of  the  American  Medical  Association  was  liberal 
and  surely  sufficient  to  guide  and  control  the  intercourse  be- 
tween medical  gentlemen  and  between  physician  and  patient. 
All  provisions  and  regulations  of  the  local  code  inconsistent 
with  and  antagonistic  to  it  should  be  stricken  out.  He  pointed 
out  several  of  these  contradictions,  and  he  maintained,  further, 
that  stringent  and  penal  regulations  accomplished  no  good. 
Honorable  gentlemen  did  not  need  them,  and  dishonorable 
men  did  not  obey  them.  Unless  penal  laws  were  rigorously 
and  impartially  enforced  the  innocent  suffered,  and  experi- 
ence had  clearly  shown  that  this  body  would  not  sustain  the 
standing  committee  in  its  efforts  to  maintain  the  authority  of 


84  ESSA  YS  AND  ADDRESSES. 

its  owG  enactments.  Hence  he  desired  the  ffood  to  be  as  free 
as  the  bad. 

He  insisted  that  the  Association  should  disconnect  itself 
from  the  Medical  Society  of  the  District  of  Columbia,  and 
not  require  a  license  from  that  organization  as  an  essential 
qualification  of  membership. 

He  claimed  that  female  physicians  should  be  allowed  con- 
sultations. While  he  was  not  the  advocate  either  of  mixed 
medical  schools  or  of  female  doctors,  and  thought  that  medi- 
cine was  not  the  calling  of  women,  still  he  was  not  forgetful 
of  the  fact  that  in  times  past  women  had  risen  to  distinction 
in  the  profession,  and  believed  there  was  more  than  one  then 
living  destined  to  become  eminent. 

If  it  was  an  evil,  it  was  such  an  evil  that  neither  this 
organization  nor  the  entire  medical  profession  of  the  country 
could  abate,  and  hence  it  was  the  part  of  wisdom,  justice,  and 
humanity  to  strike  from  their  regulations  all  provisions  pro- 
hibiting the  members  from  consulting  with  female  doctors. 

This  Association  purported  to  be  a  voluntary  organization, 
but  its  arbitrary  and  illiberal  regulations  made  membership 
compulsory,  because  it  denied  to  regularly  educated  physicians 
rights  and  privileges  which  belonged  to  them  as  physicians, 
and  required  them  to  seek  admission  to  secure  such  rights. 
He  maintained  that  consultations  were  for  the  benefit  of  and 
belonged  to  the  patients,  aud  that  no  local  society  had  a  right 
to  restrict  consultations  to  its  own  membership.  The  regula- 
tion of  the  American  Medical  Association  governing  consulta- 
tions was  wise  and  humane,  and  nothing  more  was  necessary. 
By  denying  consultations  to  those  not  members  and  to 
females  they  punished  the  sick,  denied  to  them  the  medical 
advice  they  desired,  controlled  members  who  wished  to  main- 
tain the  integrity  of  the  Association,  and  by  failing  to  punish 
those  who  violated  its  regulations  permitted  those  of  question- 
able honor  to  seek  and  solicit  the  patronage  of  the  non-mem- 
bers, to  the  injury  of  many  members. 

He  was  opposed  to  the  restriction  placed  upon  professional 


ESSA  YS  A  NI)  A  I)  I) II  I'lSSKS.  85 

inlciToiirsd  witli  army  and  navy  Kiirj^eons  8tation(<l  in  this 
city  and  raillil'iilly  (li.scliarging  the  diiticH  irnjxi.scd  iip'iti  tlicrn 
by  law.  PLc  maintained  that  it  was  a  gross  injustice  to  rc- 
quire  thera  to  b(!<;ome  mcmhiu'S  of  this  organi/iition  to  ol»tain 
consultations  with  the  o\\\\  faculty,  and  derogatory  to  their 
dignity.  As  the  regulations  tlu^n  stood  they  were  n'f|nired 
to  obtain  a  license  from  the  Medical  Society  of  the  District 
of  Columbia,  and  then  with  that  as  their  essential  credential 
to  apply  for  admission  to  this  body,  or  else  those  whom  they 
might  be  called  upon  to  attend  among  the  army  and  navy 
families  stationed  or  residing  in  this  city  could  not  obtain 
the  professional  advice  of  a  practitioner  in  civil  life  in  con- 
sultation with  such  surgeons — a  monstrous  injustice  to  the 
members  of  this  Association. 

He  was  opposed  to  the  admission  of  medical  men  employed 
as  clerks  in  the  departments,  not  because  they  were  necessa- 
rily incompetent,  as  had  been  asserted,  but  because  from  the 
nature  of  their  employment  they  could  not  be  thoroughly 
identified  with  the  profession.  He  was  willing  to  concede 
to  them  every  right  necessary  to  qualify  thera  to  pursue  their 
profession  during  their  leisure  hours,  but  he  was  unwilling  to 
clothe  them  with  authority  to  regulate  the  practice  of  medi- 
cine in  this  District,  to  enact  penal  regulations,  to  limit  and 
prescribe  the  duties  of  men  whose  entire  lives,  time,  and  abili- 
ties were  exclusively  devoted  to  the  practice  of  medicine.  He 
would,  therefore,  so  revise  the  regulations  as  to  do  away  with 
the  requirements  of  membership  to  secure  privileges  which 
ought  not  to  be  denied.  Membership  should  l^  voluntary. 
It  was  compulsory  as  long  as  it  was  necessary  to  secure  rights. 

The  Association  had  but  two  purposes — to  maintain  a  Code 
of  Ethics  and  to  establish  a  schedule  of  fees — and  owed  its 
existence  to  the  fact  that  the  charter  of  the  Medical  Society 
of  the  District  of  Columbia  prohibited  that  organization  from 
doing  either.  It  was  a  clear  and  palpable  evasion  of  the  intent 
and  purpose  of  that  law,  and  always  appeared  to  him  to 
have  been  formed  by  men  who  at  that  time  (1833)  had  all  the 


86  ESSAYS  AND  ADDRESSES. 

practice  and  were  determined  to  retain  it  while  they  lived. 
He  did  not  believ^e  that  any  young  man,  however  pure  and 
honorable  he  might  be,  could  stand  squarely  up  to  the  letter 
and  spirit  of  the  regulations  and  ever  have  a  profitable  busi- 
ness among  the  resident  population. 

He  was  willing  to  concede  the  probable  advantage  of  some 
few  general  regulations  governing  fees — perhaps  a  minimum 
limit;  but  he  was  opposed  to  the  details  of  a  schedule.  The 
physician  and  patron  should  determine  the  compensation  by 
the  character,  importance,  amount,  and  appreciation  of  the 
services  rendered.  If  the  man  of  twenty  years'  experience  or 
the  specialist  who  had  devoted  his  time  and  talent  to  the  study 
of  a  particular  class  of  diseases  was  worth  no  more  than  the 
graduate  fresh  from  college,  then  experience,  study,  and  ob- 
servation went  for  nothing.  The  exactions  of  a  fee-bill  were 
unjust  to  a  man  of  experience  and  to  the  beginner.  In  the 
former  case  too  much  labor  was  imposed  to  realize  a  compe- 
tent support.  He  was  overtasked  with  work,  and  his  remu- 
neration was  in  proportion  to  the  amount  of  work,  without 
proper  appreciation  of  the  merit  and  quality  thereof.  The 
beginner  was  required  to  estimate  his  services  at  the  same 
value  as  the  skilled  and  experienced  physician,  and  hence  he 
was  brought  in  direct  competition  with  him  on  a  basis  of 
compensation.  Surely  it  must  be  manifest  that  upon  such 
a  basis  the  skilled  would  reap  the  rewards,  while  the  unskilled 
would  stand  idly  by. 

He  finally  expressed  his  conviction  that  penal  codes  failed 
either  to  maintain  or  to  elevate  the  dignity  and  purity  of  the 
personnel  of  the  profession.  If  they  wished  to  raise  the  stand- 
ing of  the  profession,  it  must  be  by  individual  emulation  in 
professional  qualification,  in  dignity,  and  in  honorable  and 
manly  bearing.  He  would  widen  the  contrast  between  merit 
and  incompetency,  between  honor  and  dishonor,  between  the 
man  of  unflinching  integrity  and  the  man  who  by  manoeuvres, 
cunning,  and  unworthy  artifice  sought  to  subsidize  the  con- 
fidence and  respect  of  a  community.     He  would  hold  the 


ESS  A  YS  A  Nl)  A  I)  I)  It  fCSS/CS.  H  7 

membership  as  somethinjjj  distinetivf — a  liiif  of  .separation 
between  tlu;  worthy  and  unworthy.  Wliilc  meniberHhip  was 
necessary  to  Heeiin;  j)rivil(^}jj(!S  and  rights  whirh  |)roperly  atid 
legally  belonged  to  every  regular  praetitioner  of  rnedirinf, 
whether  worthy  or  unworthy,  the  implied  obligation  rested 
upon  thern  to  admit  every  a|)pli('ant,  however  low  in  morality 
or  deficient  in  qualifi(!ations.  Let  the  applicant  come  volun- 
tarily, seeking  a  badge  of  honor  and  distinction,  and  not  be 
driven  to  them  by  their  arbitrary  regulations. 


THE    GATHERING,     PACKING,     TRANSPORTA- 
TION,   AND   SALE   OF    FRESH   VEGE- 
TABLES AND  FRUITS; 

Their  Chemical  Constitution  and  Nutritive  Value; 

Competent  Inspection  and  Free  Markets 

FOR  ^Producers. 

DELIVERED  AT   THE    ANNUAL    MEETING  OF   THE  AMERICAN 

PUBLIC  HEALTH  ASSOCIATION,  IN  PHILADELPHIA, 

NOVEMBER    11,    1874. 

It  is  not  my  purpose,  at  present,  to  discuss  this  question 
in  all  its  important  relations  to  the  health  of  cities  and  of 
communities  of  consumers,  but  briefly  to  invite  the  attention 
of  this  Association  to  a  few  suggestive  inquiries,  with  the 
view  of  securing,  through  a  competent  committee,  a  thorough 
consideration  of  the  effects  upon  public  health  of  the  deterio- 
ration of  fresh  vegetables  and  fruits,  as  offered  for  sale  in  the 
markets  of  the  principal  cities  of  this  country,  and  how  far 
this  deterioration  is  attributable  to  the  manner  of  gathering, 
mode  of  packing,  and  transportation  from  the  farm  or  garden 
to  the  city  markets. 

No  one   will   maintain   that  masses  of  consumers   can    be 


88  ESSAYS  AND  ADDRESSES. 

supplied  with  vegetables  and  fruits  in  the  same  state  of  fresh- 
ness and  perfection  as  the  rural  population,  for  all  must  admit 
that  under  the  most  favorable  conditions,  with  every  requisite 
care,  many  vegetables  and  fruits  rapidly  lose  freshness,  flavor, 
and  nutrient  qualities.  The  state  of  perfect  maturity  speedily 
passes,  and  deterioration  and  decay  begin.  So,  likewise, 
must  it  be  conceded  that,  as  a  rule,  fresh  and  mature  vege- 
tables, in  their  proper  seasons,  contribute  to  enjoyment  and 
health,  and  in  the  country  rarely  provoke  disease ;  and,  fur- 
thermore, I  need  hardly  remind  you  that,  in  our  American 
cities,  the  summer  intestinal  diseases  and  digestive  troubles 
usually  begin  with  the  introduction  of  certain  fresh  vege- 
tables. Here  I  shall  be  met  with  the  objection  that  the  in- 
testinal diseases  mostly  prevail  among  very  young  children, 
who  are  consumers  of  vegetables  and  fruits  to  a  very  limited 
extent,  and  that  the  rising  temperature,  so  necessary  to  the 
growth  and  maturity  of  vegetables,  together  with  the  foul 
exhalations  and  improper  hygienic  conditions,  contributes 
chiefly  to  the  production  of  the  widespread  epidemics  of  in- 
testinal diseases  which  annually  decimate  the  infantile  popu- 
lation. The  influence  of  these  agencies  I  concede;  but  I  am 
impressed  with  the  conviction  that  intestinal  diseases  as  fre- 
quently find  their  cause  in  that  which  is  ingested  as  in  that 
which  is  smelled  or  inhaled.  The  cause  is  often  something 
more  tangible  and  gustatory  than  the  fetid  and  subtle  ema- 
nations which  hygienists  have  striven  so  long  to  define  and 
to  circumscribe.  I  am  disposed  to  shield  Providence  from 
the  alleged  agency  in  the  causation  of  many  of  the  "  ills 
which  flesh  is  heir  to,"  and  to  ascribe  them  to  the  indul- 
gence of  our  own  insatiate  thirst  and  fondness  for  the  "  good 
things  of  this  world."  Even  among  very  young  children 
the  intestinal  diseases  are  frequently  directly  traceable  to  the 
ingestion  of  unwholesome  fruits  and  vegetables ;  nor  is  the 
nursling  exempt  from  the  danger,  even  though  the  delete- 
rious influence  may  only  reach  it  through  the  defective  milk- 
supply  of  the  mother  feeding  upon  immature  or  deteriorated 


ESfiAYS  AND  A  I)  I)  It  ESSES.  8 'J 

vegetables  and  fruits.'  In  tlii.s  (tomicrlion  I  will  hricfly  invite 
attention  to  a  few  iidinitlcd  facets.  Not  tliat  1  wisji  Xo  nse 
tinnn  to  >n;iintain  any  (!X(;liisiv(!  doctrine  of  caiisafion,  or  to 
oonstrtic.t  any  new  theory,  Wiit  rather  to  extend  the  field  of 
inquiry  and  to  direct  your  studies  away  from  a  too  exelu.sive 
consideration  of  the  very  pnivalentiy  received  (jpinions  and 
theories  in  regard  to  the  ever-fermenting  and  widesj)reafling 
agency  of  bad-sraelling,  impure,  and  foul  exhalations,  as  the 
chief  and  segregate  cause  of  summer  intestinal  diseases. 

Intestinal  diseases,  both  among  adults  and  children,  are 
comparatively  rare  in  the  farming  regions,  and  both  classes 
of  the  rural  population,  adult  and  infantile,  are  more  gener- 
ally consumers  of  fruits  and  vegetables,  anrl  suffer  less  detri- 
ment therefrom,  than  like  classes  of  the  population  of  cities. 
Far  the  larger  proportion  of  infantile  intestinal  diseases  occurs 

1  The  influence  of  lactation,  both  natural  and  artificial,  in  the  causation  of  infantile 
intestinal  diseases,  is  far  too  frequently  overlooked.  Milk  is  the  natural  aliment  of 
young  animals,  but  the  nursling  is  very  frequently  fed  exclusively  upon  milk  wholly 
delicient  in  the  necessary  nutrient  and  healthy  constituents,  and,  indeed,  often  upon 
it  when  it  is  diseased.  The  unwholesome  and  sometimes  pernicious  changes  pro- 
duced in  the  mother's  milk  by  sudden  bursts  of  passion,  by  a  nervous  temperament, 
by  menstruation  and  pregnancy,  by  excessive  sexual  indulgence,  by  irregular  habits 
of  life,  and  by  certain  articles  of  diet,  are  too  well  established  by  clinical  observation, 
if  not  by  chemical  analysis,  to  be  considered  as  mere  coincidences  unworthy  of  the 
attention  and  careful  scrutiny  of  the  scientific  physician.  Decaisne  {London  Lancet, 
September,  1872)  has  shown  that  insufficient  food  may  occasion  very  serious  and  varied 
disturbances  of  the  quality  of  the  milk.  In  his  report  to  the  Academie  des  Sciences 
of  the  results  of  his  observations  of  forty-three  women  who  nursed  their  infants 
during  the  siege  of  Paris,  he  deduced  the  conclusions  that  some  women  may,  upon 
insufficient  diet,  produce  abundant  and  rich  milk,  and  their  children  will  thrive, 
while  they  themselves  will  emaciate.  Another  class  will  produce  but  httle  milk,  and 
that  very  poor,  and  their  children  will  suffer  for  want  of  nutriment  and  sicken  with 
choleraic  diarrhoea,  and  a  third  class  will  produce  scarcely  any,  and  their  children 
will  die.  In  syphilitic  mothers  the  proportion  of  sugar  is  diminished  and  water 
increased  in  the  milk ;  fever  lessens,  and  may  suppress  the  secretion ;  emotion,  mental 
anxiety,  and  sorrow  may  diminish  it  or  render  it  poisonous  ;  puerperal  fever  seriously 
disturbs  its  healthy  qualities ;  insufficient  air,  sedentary  habits,  and  want  of  cleanli- 
ness not  infrequently  impart  to  it  conditions  injurious  to  the  health  of  the  nursling. 
Certain  drugs  administered  to  the  mother  may  affijct  the  infant.  Iodine  can  be 
detected  in  the  milk  ;  mercury  given  to  syphilitic  mothers  will  be  conveyed  to  the 
suckling  ;  opiates  and  some  purgatives  will  demonstrate  their  physiological  effects 
upon  the  infant.  Lettuce  imparts  its  qualities  to  the  milk,  yielding  "  when  inspis- 
sated (Redwood)  lettuce  opium,  or  lactiicimum."  Garlic,  the  onion,  cabbage,  turnips, 
and  even  green  clover  will  impart  a  distinctive  aroma  to  the  milk  of  cows  feeding 
upon  them.  But  more  important  are  the  facts  that  the  quality  and  quantity  of  the 
milk  are  dependent  upon  the  character  of  the  food  and  the  vigor  and  healthfulness 
of  the  digestion.  A  meagre  diet  affects  almost  exclusively  the  quantity  of  butter  and 
casein  ;  a  bad  diet  imparts  deleterious  qualities. 


90  ESSAYS  AXB  ADDBESSES. 

among  those  beyond  the  age  of  six  months — that  is,  subsequent 
to  the  period  at  which  the  natural  aliment  is  usually  consid- 
ered by  the  laity  adequate  to  the  demands  of  growth  and  de- 
velopment ;  and  far  the  larger  percentage  of  mortality  occurs 
among  the  children  of  the  poor  and  squalid  residents  of  cities 
— the  class  necessarily  the  most  indiscreet  consumers  of  cheap 
and  deteriorated  vegetables  and  fruits.  Statistics  establish 
the  greater  prevalence  of  these  diseases  between  the  ages  of 
six  and  thirty  months,  and  among  the  artificially  fed,  and 
greater  proportionate  mortality  in  the  densely  populated  dis- 
tricts, and  among  the  children  of  the  poorer  classes.  Can  it 
be  that  those  under  six  months,  those  advanced  beyond  thirty 
months,  and  those  nursed  at  the  breast  are  less  exposed  to 
and  less  impressible  by  atmospheric  influences  ?  Undoubt- 
edly the  intercurrent  affections  and  developmental  peculiari- 
ties of  the  period  exercise  very  considerable  influence  in 
predisposing  to  intestinal  disease;  but,  assuredly,  improper 
alimentation  must  constitute  the  chief  among  the  many  fac- 
tors concerned  in  the  etiology.^  It  is  then  manifest  that 
intestinal  diseases  are  most  prevalent  during  the  warmer 
months  of  the  year — June,  July,  August,  and  September, 
when  vegetables  and  fruits  are  most  abundant  and  deterio- 
ration most  rapid — are  proportionately  far  more  frequent 
among  communities  of  consumers  who  can  only  obtain  sup- 
plies by  purchase,  and  are  most  fatal  among  the  poor,  who 
from  necessity  become  the  purchasers  of  the  cheapest  and 
most  deteriorated. 

These  significant  facts  are  not  adduced  to  disprove  the 
manifold  ill  effects  of  a  bad  atmosphere  and  of  fetid  exhala- 
tions,  but  to  invite  your  attention  to  the  consideration   of 

1  starchy  aliments  are  indigestible  in  consequence  of  the  feebleness  of  the  diges- 
tive properties  of  the  salivary,  pancreatic,  and  intestinal  juices  of  young  children. 
They  are  also  deficient  in  "  materials  for  the  re-integration  of  the  principal  tissues, 
which  is  so  necessary  to  the  growing  infant."  Sonsino  established  the  condition  of 
"physiological  dyspepsia  in  infants  for  starchy  aliments."  Korowin  has  deduced  the 
conclusion  from  a  series  of  experiments  that  the  property  of  the  pancreatic  juice  to 
transform  starch  into  sugar  is  only  manifest  after  the  third  month  of  life,  but  that 
the  parotidean  saliva  possesses  this  power  from  birth.  In  regard  to  both  secretions, 
this  power  becomes  more  active  with  the  development  of  the  child. 


/';S',SM  VS  AND  ADDIiKSSICS.  01 

aiiotliiT  :m<l  [x-i-liaps  :is  ri-(>i|Ui'iil,  aiid  (Wvi'cX  an  aijjcncy  in  tlif; 
cauHatioii  of  iiil-(!Htiii:iI  disf-aHcs;  aii<l  lo  illuHtrate,  a8  wH,  tlio 
C()in[)anitiv(!  iimonioiisiicsH  of  frcsli,  iiiatiin!,  and  j)roj)frly 
f^atluTod  frnilH  and  vc^ctabU'S,  as  to  dotnonstralc  flifir  |)('nii- 
cioiis  and  disease-producing  qualities  as  supplied  to  and  fon- 
sumcd  by  tlus  inlial)itan(s  of  (Mtlcs. 

To  elaborate  further  the  distinct  question  iiere  at  issue — 
the  airency  of  immature  and  deteriorated  fruits  and  vegetables 
in  producing  intestinal  diseases,  and  the  more  strikingly  to 
exhibit  the  qualitative  changes  which  they  speedily  undergo 
after  preparation  for  market — I  shall  select  a  few  of  those  most 
geuerally  consumed  and  describe  the  mode  of  gathering,  pack- 
ing, and  conveying,  and  their  condition  when  exposed  for  sale. 

The  Irish'potato  [Solanwn  tuberosum),  perhaps  the  most  pop- 
ular aliment  supplied  from  the  ^'  truck  farm,"  when  mature 
and  properly  cooked,  is  a  wholesome  and  nutritious  article  of 
diet,  carries  well,  and  preserves  its  flavor  and  nutrient  quali- 
ties, even  in  very  warm  weather,  for  a  reasonable  time.  It 
has  a  stage  of  ripeness,  marked  l)y  a  thick  and  firmly  ad- 
herent skin,  and  when  cooked  breaks,  upon  very  gentle 
pressure,  into  a  semi-dry,  mealy  mass.  In  this  condition  the 
producer  supplies  them  to  his  own  family.  Young  children 
consume  them  with  comparative  impuuity.  In  the  early 
spring  we  are  usually  supplied  from  Bermuda  with  a  variety 
which,  as  a  rule,  is  in  a  fair  state  of  preservation ;  but  the 
general  demand  and  high  price  soon  draw  a  supply  in  suc- 
cession from  Savannah,  Charleston,  Norfolk,  and  the  farms 
in  the  immediate  vicinity.  The  tubers  are  gathered,  not  be- 
cause they  are  ripe,  but  because  they  are  merchantable — that 
is,  have  attained  sufficient  size;  perhaps  washed,  better  not, 
packed  in  barrels  and  transported  to  the  place  of  sale.  In 
this  tender,  succulent,  and  growing  state  they  are  easily 
bruised,  have  a  smooth,  thin,  delicate,  and  slightly  adherent 
surface-covering;  and  we  find  them  in  market  with  partially 
peeled  and  ragged  surfaces,  the  loosened  parts  of  the  cuticle 
partially  attached  to  the  remaining  adhering  pieces.  These 
are  the  unavoidable  results  of  gathering   before   maturity, 


92  ESSAYS  AND  ADBBESSES. 

rough  baudling,  improper  packing,  and  of  the  heating- 
process — preliminary  to  other  deteriorating  changes  through 
which  they  wholly  or  partially  pass  before  they  are  exposed 
for  sale.  The  extent  of  these  degenerative  changes  is  pro- 
portionate to  the  lapse  of  time  and  closeness  of  packing,  and 
perhaps  also  to  the  mode  of  transportation.  The  heating,  or, 
rather,  steaming,  process  favors  the  detachment  of  the  par- 
tially developed  cuticle,  as  it  does  of  the  matured  skin.  I 
need  hardly  inform  you  that  the  destruction  or  removal  of 
the  surface-covering  which  nature  provides  for  protection  and 
preservation  favors  and  hastens  the  decay  of  all  perishable 
fruits  and  vegetables.  Such  tubers  cook  waxy,  cut  cheese- 
like, bite  doughy,  and  taste  greenish  and  weedy.  They  are 
served  upon  our  tables  with  savory  dressings  and  eaten  with 
relish,  but  they  are  only  partially  digestible,  and,  in  the  main, 
pass  from  the  bowels  in  white,  doughy,  unaffected  lumps.  Of 
the  consumers  some  escape  unhurt,  some  suffer  a  pang  or  two, 
others,  fortunately,  purge  freely,  but  the  less  fortunate  suffer 
more  seriously.  To  many  young  children,  whose  digestive 
powers  are  inadequate  to  the  complete  digestion  of  any  starchy 
aliment,  these  tubers,  mashed  and  commingled  with  savory 
gravies,  are  fed  as  choice  and  nutrient  morsels,  and  when 
sickness  and  suffering  come,  the  temperature — not  above  70° 
at  mid-day — or  some  distant  slaughter-house  or  bone-boiling 
establishment  is  charged  with  the  dire  calamity.  The  potato 
probably  ripens  from  exterior  to  centre;  hence,  after  cooking, 
it  may  frequently  be  observed  that  immediately  under  the 
apparently  ripened  skin  a  layer  of  greater  or  less  thickness, 
according  as  the  stage  of  ripeness  has  advanced,  of  a  semi- 
dry,  farinaceous  mass,  will  scale  from  a  firm  and  waxy  cen- 
tral portion,  so  that  one  may  be  deceived  by  the  manifest 
external  evidences  of  ripeness.  The  potato  deteriorates  by 
growing  out  or  germinating.  If  left  in  the  ground  long  after 
maturity,  during  a  growing  season,  from  one  or  more  of  the 
buds  or  eyes  will  grow  appendages  resembling  in  every  re- 
spect the  mother-tuber — they  are,  in  fact  homologous  out- 
growths.    The  presence  of  such  a  tumor  is  the  evidence  of  a 


ESS  A  YS  A  ND  A  I)  DRESSES.  93 

■second  jijrovvlli,  mikI  if  Wrokfii  off,  as  in  iisually  tlio  case  when 
off(M'0(l  ("(ir  ,sal(!,  tlu!  Hiirfact;  is  (Icmidcid  at  the  point  f)f  atlacli- 
nient.  WIkmi  irnproix'i-Iy  stor(;d,  and  (!sj)(:cially  diirinfr  the 
hUer  .sprint;  months,  th(!  tubers  germinate,  and  from  each  eye 
rootlets  slioot  forth,  which  arc;  likewise  broken  off  before  beinj^ 
exposed  for  sale,  but  the  snrfaee  exhibits  no  denudation,  and 
the  condition  c&,u  only  be  detected  by  a  very  careful  inspec- 
tion of  the  buds,  and,  perhaps,  a  softer  feel.  The  density 
may  have  diminished  because  of  the  eomraeneement  of  germi- 
nation. Freezing  destroys  the  organization  of  the  potato, 
and  with  thawing  the  putrefactive  changes  begin.  Notwith- 
standing, it  is  a  very  common  occurrence  for  dealers  to  offer 
and  for  consumers  to  purchase  frozen  potatoes.  "  The  potato," 
says  Pavy,  "  is  made  up  of  cells,  penetrated  and  surrounded 
by  a  watery,  albuminous  juice,  and  filled  with  a  number  of 
starch-granules."  Cooking  coagulates  the  albumin,  and  the 
starch -granules  absorb  the  watery  part ;  hence  the  cells  are 
distended,  and  their  cohesion  being  destroyed  the  potato 
breaks  down  into  a  'Moose,  farinaceous  mass."  ''Young 
potatoes  "  (Chambers's  llanual  of  Diet,  p.  43),  "  from  not  so 
easily  breaking  up,  require  long  mastication  to  render  them 
soluble,  and  are  not  then  very  digestible;  but  old,  waxy 
potatoes  are  worse,  for  they  seem  to  unite  again  into  a  sticky 
mass  after  being  swallowed,  and  remain  for  hours  undis- 
solved." The  worst  of  all  are  potatoes  affected  with  disease. 
The  potato  contains^  per  ounce  (437.5  grains),  in  its  natural 

1  Perceutage-amount  of  ash  1  to  1.5.    Mineral  constituents  in  100  grains  of  ash : 

Way.         Fromberg. 

Potash 46.60  50.23 

Soda         3.7 

Magnesia 8.70  4.4 

Lime 4.54  0.83 

Phosphoric  acid 13.30  10.10 

Sulphuric  acid 4  66  14.67 

Chloride  of  potassium 17.76 

Chloride  of  sodium 3.43 

Carbonic  acid  (from  the  incineration  of  the  or- 
ganic acids) 13.30 

Oxide  of  iron 

SUicate  of  alumina 1.95 

— Parkes,  Pract.  Hygiene,  4th  ed.,  p.  236. 


94  ^  ESSAYS  A^W  ADDRESSES. 

state,  324  grains  of  water,  1  of  nitrogeu,  49  of  earbou,  and 
4.4  of  salts.  These  elements  vary  much  (Smith)  with  the 
season,  variety,  ripeness,  and  soil.  The  nutrient  value  of  the 
potato  is  determined  by  its  specific  gravity  ;^  the  heavier  auy 
given  tuber  is  according  to  its  size  the  greater  amount  of 
starch  it  contains.  The  relative  proportion  of  solid  constitu- 
ents can  be  ascertained  (Parkes,  p.  237)  by  multiplying  the 
specific  gravity  by  a  factor  taken  from  the  table,^  and  if  it 
be  desirable  to  ascertain  the  percentage  of  starch,  multiply  the 
specific  gravity  by  the  factor  less  7.  If  the  specific  gravity 
of  the  potato  is  below  1068,  the  quality  is  bad  (Parkes). 

Between  1068-1082,  the  quality  is  inferior. 

Between  1082-1105,  the  quality  is  rather  poor. 

Above  1105,  the  quality  is  good. 

Above  1110,  the  quality  is  best. 

The  potato  should  be  cooked  with  the  skin  on,  and  well 
boiled  or  thoroughly  steamed,  otherwise  the  starch  is  not 
easily  digested  ;  and  if  the  cooking-process  is  rapid,  the  cellu-' 
lose  and  albuminates  become  hard.  For  the  sick,  Chambers 
(loo.  ciL,  p.  244)  prescribes  the  following  method: 

"  Boil  one  pound  of  potatoes  with  their  jackets  on  till  they 
are  tender  or  brittle.  Peel  them,  and  rub  them  through  a 
fine  sieve ;  when  cool  add  a  small  teacupf ul  of  fresh  cream 
and  a  little  salt,  beating  the  puree  up  lightly  as  you  go  on 
till  it  is  quite  smooth,  and  warming  it  up  gently  for  use." 

With  a  knowledge  of  the  structure  and  composition  of  the 
tuber  it  is  easily  understood  why  bruising,  peeling,  germina- 
tion, and  freezing  should  promote  degenerative  change.  Any 
change  which  increases  its  very  large  proportion  of  water 

I 

1  This  may  be  ascertained  by  throwing  several  potatoes  into  a  strong  solution  ol 
salt,  and  then  adding  water  until  some  of  them  sink,  and  others  swim.  The  specific 
gravity  of  the  solution  will  represent  that  of  the  potatoes  as  a  whole.  Smith,  Food, 
p.  199. 

2  Specific  gravity  ^    ^  Specific  gravity  p-p^t^r 

between  ^^''^'-  between  ^''''^^' 

1061-1068        ...      16  1105-1109        ...      24 

1069-1074        ...      18  1110-1114        ...      26 

1075-1082        ...     20  1115-1119        ...      27 

1083-1104        ...     22  1120-1129        ...      28 


I'JSSA  K,S'  A.\I>  ADDIIKSSES.  95 

diniiniHlics  Itn  nilativo  niilntivc  <|iiality  and  lia.stfns  llic  dc- 
BtriKilivo  pnxtcss.  Tlic  tiilx-r  hIioiiM  Ik;  firm  and  '-iit  with 
crispncsH.  The;  cliicf  value  of  tli(!  [xdato  licH  in  itn  antiwor- 
butic  projjertios.  ''  Ten  frraiiiH  (Smith)  of  |)otalo  confiumcd  in 
the  body  j)r()diui(!  heat  siifTicient  (o  raise  20  pounds  of  water 
1°  F.,  or  to  lift  1977  pounds  one  foot." 

The  pea  (Pisum  sativum),  as  a  fresh  vegetable,  is  eaten 
unripe,  hut  should  have  n^ac^hed  tlie  stage  of  maturity  wlun 
the  seed-husk  is  filled.  It,  like  the  potato,  comes  first  from 
the  far  South,  and  successively  from  nearer  regions.  As  a 
fresh  vegetable  pease  bear  transportation  badly,  soon  wilt, 
heat,  wither,  shrink,  fade,  and  deteriorate  after  having  been 
gathered  and  packed.  It  is  a  tedious  crop  to  gather  and  a 
bulky  product  to  transport.  The  producer  gathers  his  table- 
supply  during  the  forenoon,  perhaps  before  the  morning  sun 
has  evaporated  the  dew  from  the  leaves  and  seed-pods.  Upon 
his  table  the  pea  is  a  delicious,  inviting,  and  richly  flavored 
vegetable,  seeming  to  dissolve  during  the  process  of  mastica- 
tion, and  digests  without  inconvenience.  For  the  market 
the  crop  is  more  frequently  gathered  when  too  far  advanced 
toward  ripeness  than  before  the  fitted  stage  of  development 
— and  for  the  obvious  reason  that  transportation  is  better 
borne  and  the  loss  is  less  from  shrinkage.  Usually  the  gath- 
ering is  done  during  the  heat  of  the  day,  because  of  less  injury 
to  the  vine  while  wiltering  under  a  blazing  sun  ;  but  the  pru- 
dent farmer  never  enters  his  pea-patch  until  the  gathering  is 
ready  for  his  '^  pickers" — that  is,  when  the  hand  can  pluck 
a  number  of  pods  at  a  single  grasp,  for  he  wisely  estimates 
the  cost  of  time  lost  in  clutching  at  single  pods,  and  knows 
too  well  that  the  loss  in  price  by  a  few  days'  delay  will  be 
abundantly  made  up  by  the  increased  measurement  from  the 
too  far  advanced  and  ripened  seed-pods.  Thus  gathered, 
they  are  immediately  packed  in  barrels  and  transported  to 
market.  Very  speedily  the  heating-process  begins,  and  during 
a  few  hours  the  temperature  in  the  centre  of  such  a  bulk  will 
rise  considerably  above  blood-heat,  and  when  emptied  upon 
the  salesman's  stand  the  subsequent  morning  the  loosened 


96  ESSAYS  AND  ADDRESSES. 

bulk  will  emit  an  amazing  volume  of  smoke — condensing 
steam ;  or  perhaps  more  time  has  elapsed,  and  the  heating- 
process  has  been  completed,  succeeded  by  other  destructive 
changes.  The  seed-pods  have  lost  their  fresh  and  pea-green 
color,  their  crispness  and  resiliency ;  have  faded  and  with- 
ered— flattened,  as  the  salesman  will  tell  you,  by  pressure,  but 
in  fact  by  the  loss  of  natural  moisture  expelled  by  the  steam- 
ing-process.  The  contained  seeds,  the  only  edible  portion, 
have  lost  entirely  their  peculiar  luscious  flavor,  have  acquired 
toughness  and,  to  a  greater  or  less  degree,  hardness,  and  the 
seed-husk  no  longer  submits  to  ordinary  digestion.  Each 
seed  must  be  crushed  between  the  molars,  or  else  may  roll 
through  the  alimentary  canal,  except  for  the  preliminary 
cooking,  conditioned  for  a  vigorous  vegetation.  The  seed- 
pulp  contains  all  the  nutrient  qualities,  but  cannot  be  sepa- 
rated from  the  husk  in  the  green  state.  The  husk  acquires 
firmness  as  the  seed-pulp  jarogresses  to  complete  development, 
and  loses  color  through  the  ripening-process.  It  is  better  to 
select  for  the  table  undeveloped  rather  than  past-developed 
peas,  and  small,  immature  pea-green  pods  rather  than  the 
faded  and  ripening  ones.  The  peculiar  greenish  hue  is  an 
essential  characteristic  of  freshness. 

"  They  should  (Chambers)  be  young,  and  their  skins  tender 
enough  to  crack  in  boiling."  In  such  condition  they  are 
sweet,  easily  digested,  but  less  nutritious  than  when  fully 
matured.  "  When  old  (Chambers,  Pavy)  no  amount  of 
boiling  will  soften  them  ;  indeed,  the  longer  they  are  boiled 
the  harder  they  become." 

When  dried  they  are  deprived  of  their  husks  before  cook- 
ing, and  when  thoroughly  boiled  constitute  a  good  article  of 
diet  for  those  blessed  with  vigorous  digestion. 

Composition  of  the  Dried  Pea  (Paye  n). 

Nitrogenous  matter 23 .8 

starch,  etc 58.7 

Cellulose 3.5 

Fatty  matter 2.1 

Mineral  matter 2.1 

Waxer 8.3 


ES8A  YS  A  Nl)  A  DDIIESSES.  97 

Beans.  JicariH  arc  ev<'ii  iiion;  jK'riHhal)l(!  tlinn  jicaHf!.  Ah  a 
fronli  v('f];(!tiil)Ic,  holli  jhxIh  and  hwxX  an;  ('(lihlo,  and  in  tlifir 
liigliost  perftu'tioii  for  the  table  tlicy  must  be  youn^,  flenliy, 
brittle,  and  tender.  The  Huceulence  and  flcshineHH  of  the  pods 
invite  destructive  changes,  and  in  bulk,  closely  ])acked,  rot 
soon  begins.  Hence  it  becomes  the  interest  of  the  distant 
grower  to  delay  the  gathering  beyond  the  stage  of  dietary 
perfection;  and,  consequently,  of  the  city  consumer  to  pur- 
chase liis  sujiplies  from  the  growers  of  liis  vicinage.  Beans 
should  bo  pac^ked  loosely  in  siuall  bulk  and  in  crates.  A 
coarse  vegetable  at  best,  but  nutritious  and  harmless  when  in 
proper  condition.  They  are  cheiip,  and  therefore  popular 
among  the  poorer  classes.  As  the  pods  ripen  color  fades, 
dryness  increases,  and  they  become  tough  and  tasteless.  Cattle 
will  not  eat  them.  Even  when  gathered  in  proper  condition 
and  properly  packed  deterioration  soon  begins,  and,  though 
not  actually  rotten,  the  loss  of  succulence  and  brittleness 
denotes  changes  which  unfit  such  pods  for  table-use. 

Beans  are  sometimes  improperly  eaten  as  salad,  in  the 
preparation  of  which  vinegar  should  never  be  used,  for  it 
renders  the  legumiu  insoluble,  and  thus  prevents  digestion. 

Composition  of  Dried  Beans  (Pa yen). 

Horse  bean.       Windsor  bean. 

Nitrogenous  matter 30.8  29.05 

Starch 48.3  55.85 

Cellulose 3.0  1.05 

Fatty  matter 1.9  2.00 

Saline  matter 3.5  3.65 

Water 12.5  8.40 

100.0  100.00 

The  leguminosae  are  rich  in  nitrogenous  matter,  and  ap- 
proximate in  nutritive  value  the  products  of  the  animal 
kingdom.  They  possess  the  special  advantage  of  combining 
sulphur  and  phosphorus  with  the  vegetable  casein  ;  but  in 
consequence  of  the  indigestibility  of  the  legumin  about  6.5 
per  cent,  is  lost,  and  escapes  with  the  excremeutitious  matter, 
and  much  flatus  (Parkes)  is  also  produced  by  the  formation 

7 


98  ESSAYS  AND  ADDRESSES. 

of  sulphuretted  hydrogen.  In  combination  with  other  starchy 
or  fatty  ah'meuts  they  constitute  valuable  articles  of  diet. 
Bacon  and  beans  in  this  country,  as  in  England,  has  been  a 
favorite  dish,  especially  among  the  laboring-classes,  who  are 
accustomed  to  much  exercise  and  continuous  labor. 

Tomatoes.  The  tomato  {Solanum  ly coper sicum),  so  univer- 
sally and  deservedly  popular  among  all  classes  of  consumers 
of  vegetables,  when  ripe  and  gathered  and  packed  with  ordi- 
nary care,  bears  carriage  well,  and  is  usually  supplied  to  city 
consumers  in  great  perfection.  Those  brought,  in  early 
spring,  from  the  remote  South  have  beeu  gathered  green,  are 
packed  with  very  great  care,  each  wrapped  in  a  separate  piece 
of  paper,  and  are  thus  ripened  on  their  journey.  Those  sup- 
plied from  the  near  vicinity,  after  a  killing  frost  has  bared 
the  earth  of  all  summer  vegetation,  have  been  ripened  under 
glass.  When  the  chilling  wind  and  falling  thermometer 
threaten  frost  the  grower  hastens  to  save  the  green  fruit 
upon  the  vines.  It  is  hastily  gathered  and  put  under  glass 
and  thus  colored  red — not,  in  fact,  matured.  Such  fruit 
possesses  but  little  of  the  attractive  flavor  and  nutrient  quali- 
ties which  belong  to  the  matured  and  naturally  ripened  fruit; 
but  it  finds  ready  sale,  and  is  offered  to  the  consumer  in 
the  best  condition  attainable.  It  is  the  business  of  the  pro- 
ducer to  supply  the  demand,  and  it  is  no  fault  of  his  if  the 
luxurious  palates  of  city  consumers  are  only  to  be  satisfied 
with  green  fruit  colored  red.  I  regard  the  tomato  as  a 
healthy,  agreeable,  and  nutritious  vegetable,  but  have  no 
confidence  in  its  cholagogue  or  blood-purifying  qualities,  as 
very  many  of  the  laity  believe  and  some  physicians  claim. 
In  the  flesh  reside  all  the  nutritive  and  gustatory  qualities, 
hence  they  should  always  be  peeled  preparatory  to  being 
eaten.  The  preliminary  degenerative  change  is  fermentive, 
which  rapidly  progresses  to  the  complete  destruction  of  all 
the  fleshy  part,  leaving  nothing  but  the  seed  and  thin  but 
tough  skin.  Neither  seed  nor  skin  is  digestible.  Feed  hogs 
upon  tomatoes  and  scatter  the  manure  from  the  sty  upon  a 


KSSA  VS  AND  Al ) I ) I i liSS EH.  [)[) 

barren  field,  iind  f()inat<)-[>liuilH  will  flitiiiisli  like  noxioufl 
weeds.  (Jornmiriifie  tlio  refuse  skins  with  h1o|),  and  flie 
hog  will  <^•u•('fldIy  avoid  tlicm,  leaving  tlifrn  in  tlie  vcHsel 
from  which  he  Cccd.s.  Jiot  will  very  slowly  destroy  toniato- 
slcins.  Throw  them  into  a  cesspool,  and  they  will  offer  an 
obstinate  re.sislanei'  to  the  putrefactive  process.  They  dis- 
appear through  disintegration  by  dryness.  Notwithstanding 
all  this,  some  foolish  people  will  insist  that  the  choicest  part 
of  this  popular  vegetable  is  the  skin,  and  not  infrequently  I 
have  known  young  children  to  be  fed  upon  the  sliced  fruit 
without  previous  peeling  or  ordinary  care  to  avoid  the  in- 
gestion of  the  seed. 

The  following  analysis^  is  by  Dr.  B.  F,  Craig,  of  this  city: 

"  A  can  of  tomatoes  was  found  to  contain  2.04  pounds 
avoirdupois,  of  which,  however,  only  0.05  pound  (22.75 
grains)  were  solid  matter,  dried  at  212°  F.  There  was, 
therefore,  97.6  per  cent,  of  water  present. 

"  The  acid  of  the  tomato  I  found  to  be  malic,  with  a  trace 
of  citric,  the  amount  of  the  free  malic  acid  being  equivalent 
to  315  parts  in  100,000,  or  a  little  over  three-tenths  of  1 
per  cent.  (Lemon-juice  contains  about  twenty-five  times  as 
much  free  acid.)  In  tomatoes  there  is  about  as  much  more 
malic  acid  in  combination  with  bases. 

' '  The  amount  of  vegetable  acid — its  proportion  to  the  total 
solid  matter — is  of  itself  enough  to  make  tomatoes  valuable 
as  an  antiscorbutic ;  but  it  certainly  seems  desirable,  in  can- 
ning them,  to  get  rid  of  the  great  excess  of  water." 

Chambers  regards  the  tomato  as  a  healthy  but  not  a  sub- 
stantive article  of  diet,  and  Pavy  regards  it  more  as  a  relish 
than  a  nutritive  element.  Surgeon  Swift  would  regard  it  as 
an  addition  to  the  army  ration  of  great  value,  if  the  excess 
of  water  could  be  disposed  of. 

Tomatoes  may  be  eaten  cooked  or  sliced  raw  as  a  salad  with 
oil  and  vinegar ;  and  are  easily  digested  when  ripe,  but  when 

1  Circular  No.  S,  Report  on  Hygiene,  xxxix. 


IGO  ESSAYS  AND  ABDBESSES. 

green  are  flatiileut.  Their  only  medicinal  property  is  exclu- 
sively derived  from  the  very  limited  quantity  o£  malic  acid, 
and  it  may  be  defined  as  mildly  antiscorbutic. 

Cucumber  (^Cucumis  sativus).  Perhaps  no  one  member  of 
the  family  of  kitchen  garden  vegetables  has  so  many  greedy 
devourers  as  the  cucumber.  There  is  something  so  refresh- 
ing and  exhilarating  about  the  appearance  of  a  dish  of  sliced 
cucumbers  prepared  for  the  table,  and  something  so  attrac- 
tive to  the  palate  in  its  peculiarly  inviting  and  mouth-water- 
ing aroma,  that  one's  self-denial  oftentimes  fails  to  protect 
the  stomach  from  the  indigestible  mass,  and  consumers  fail 
to  appreciate  the  fact  that  they  are  vigorously  masticating  an 
aroma,  deriving  but  little  if  any  sustenance.  Why  preferred 
for  the  table  before  maturity  I  do  not  know.  Swine,  I  be- 
lieve, select  the  full-grown  and  matured  fruit,  ripened  to  a 
golden-yellow  color,  as  the  choicest,  and  certainly  the  aroma 
is  more  decided  and  the  juicy  constituent  is  most  abundant 
at  maturity.  For  home-consumption  it  is  gathered  in  early 
morning,  while  chilled  by  the  morning  temperature,  and 
either  immersed  in  cold  water  or  kept  in  a  cool  place  until 
prepared  for  the  table.  Not  easily  digested  at  best,  yet  those 
who  eat  them  with  such  avidity  are  very  unwilling  to  acknowl- 
edge any  after  ill-effects,  and  it  is  assuredly  true  that  country 
consumers  usually  escape  merited  suffering.  The  cucumber 
carries  well,  resists  decay,  withers  slightly,  loses  some  in 
crispness  and  brittleness,  and  acquires  toughness,  but  retains 
flavor  for  some  days,  and  is  usually  offered  for  sale  in  a 
fair  state  of  preservation.  Without  presenting  manifest 
evidences  of  destructive  change,  it  speedily  undergoes  some 
alteration  which  renders  it  exceedingly  hurtful  to  healthy 
■digestion  and  provocative  of  intestinal  trouble.  It  would 
seem  that  these  evil  effects  were  projjortionate  to  the  loss  of 
the  watery  constituent,  and  thus  gathering  during  the  heat 
of  the  day,  exposure,  and  the  lapse  of  time  promote  those 
changes  which  so  seriously  impair  its  dietary  qualities. 

Cucumbers,  like  celery,  says  Chambers  (loc.  cit.,  p.  49),  are 


KSSA  YS  A  NI)  A  /) DRESSES.  ]()] 

not  suitable  for  oati'nj;  raw  aftnr  a  full  nic;il.  Tlu'  f|iiaiitity  "f 
woody  fil)r(!  in  liiciii  carmot  he  di^cslcd.  "  With  hrcad  and 
chocHc,  aH  a  Ii<;iit  huK^h.thcy  ^ivc  an  a<i;r(!('ahlc  zest,  and  Hccm 
to  Htiniiihitc  tlu;  .secretion  of  ^aslrie  juice."  "Stewed  they 
form  (Pavy)  a  H^lit  and  wholesome  vef^etahle. "  "  When 
made  acid  witii  vine!j:;ar  and  eaten  in  a  larj^e  fjiiantity  fSriiith) 
they  cause  pain  at  the  stomach."  Some  have  supposed  that 
the  unwholesome  property  resided  in  the  skin,  others  located 
it  in  the  juice.  It  usually  repeats  its  flavor  in  the  mouth 
some  time  after  having  been  eaten. 

The  brassica  tribe,  which  includes  all  the  varieties  of  the 
cabbage — Brussels-sprouts,  cauliflower,  broccoli,  and  kale — 
are  highly  esteemed  as  vegetable  aliments  by  many  per- 
sons, aud  especially  by  the  laboring-classes,  who  rank 
them  as  highly  nutritious,  usually  styling  the  cabbage  as 
"  strong  food. "  In  this  respect,  however,  the  popular  esti- 
mate is  far  above  their  true  value  as  foo'l.  There  may  be 
very  wide  differences  in  the  chemical  composition  of  the  sev- 
eral species  of  this  family  of  vegetables,  but  for  all  practical 
purposes  cabbage  may  be  assumed  to  represent  the  type  of 
the  class.     It  contains  in  100  parts: 

Water 91.0 

Albuminates 0.2 

Fats 0.5 

Carbohydrates 5.8 

Salts 0.7 

"  Ten  grains  of  cabbage  (Smith)  when  consumed  in  the 
body  produce  heat  sufficient  to  raise  1.12  pounds  1°  F., 
which  is  equal  to  lifting  834  pounds  one  foot  high,"  thus 
representing  less  than  one-half  the  power  of  an  equal  amount 
of  potato.  Even  this  very  feeble  nutritive  property  varies 
according  to  the  stage  of  growth  and  maturity  of  the  plant. 
Anderson  has  determined  these  variations  as  follows  : 

Young  Ripe  outer  Ripe  heart- 
plant,  leaves.  leaves. 

Water 91.8  91.1  94.4 

Nitrogenous  matter      ....       2.1  1.6  0.9 

Woody  fibre,  gum,  and  sugar     .       .       4.5  5.00  4.1 

Ash  or  salts 1.6  2.2  0.6 


102  ESSAYS  AND  ADDRESSES. 

It  thus  becomes  manifest  that  as  the  plaut  advances  to  ma- 
turity its  nutritive  property  diminishes,  and  that  the  matured 
and  bleached  heart-leaves,  usually  selected  as  the  choicest 
parts,  and  largely  consumed  as  a  salad  in  the  form  of  "  cold- 
slaw,"  consist  of  little  else  than  water  and  woody  fibre. 
The  very  large  proportion  of  these  two  constituents  not  only 
diminshes  its  value  as  an  alimentary  product,  but  renders  it 
very  difficult  of  digestion,  and  hence  inadmissible  as  an 
article  of  diet  when  the  digestion  is  enfeebled  by  disease  or 
other  conditions.  Life  could  not  be  sustained  but  for  a  brief 
period  upon  this  class  of  substances,  for  the  digestion  and 
capacity  of  the  stomach  would  prove  inadequate  to  the  wants 
of  the  system.  The  tribe  as  a  whole  may  be  very  properly 
styled  the  hay  of  the  human  race ;  but  in  fact  they  are  less 
valuable  as  alimentary  substances,  containing  less  oily  and 
nitrogenous  material.  "  Their  proportion  of  sulphur  (Pavy) 
is  large,  and  they  thus  are  apt  to  give  rise  to  flatulence  of  an 
unpleasant  nature."  For  the  table  they  should  be  young, 
fresh,  and  green  (brocoli  should  be  white) ;  blanching  is  the 
evidence  of  loss  of  nutritive  qualities, 

"  If  the  cabbage  has  begun  to  heat  from  fermentation 
(Chambers),  it  is  most  noxious,  and  generates  in  the  intes- 
tinal canal  an  enormous  amount  of  flatus,  consisting  not  only 
of  the  usual  carbonic  acid,  but  of  sulphuretted  hydrogen." 
Fermentation  destroys  the  antiscorbutic  qualities  for  which 
the  cabbage  is  so  highly  prized,  and  in  which  consists  its 
chief  value  as  an  aliment.  This  property  diminishes  with 
loss  of  freshness  and  crispness. 

It  is  the  common  belief  that  cabbage  deteriorates  very 
slowly,  and  this  prevalent  opinion  enhances  the  cupidity  of 
the  tradesman.  The  purchaser  buys  the  largest  head  for  the 
smallest  amount  of  money,  and  distributes  his  mess  of  bacon 
and  cabbage  through  as  many  meals  as  his  daily  subdivisions 
will  admit,  and  hopes  to  restore  freshness  and  crispness  by 
continuous  immersion  in  water,  forgetting  that  he  is  thus 
diluting  his  5  per  cent,  solution  of  woody  fibre  and  feeding 


I':,SSA  YS  A  NI)  A  ni)RI'JSSES.  ]  ()',>, 

hirriHolf  on  bad  wat(!r  aiul  iioxioUH  gases.  If  one  will  have 
cabbage  to  season  his  bacon  and  pork,  purehaHC  the  heads 
fn^sli,  nnstripped  of  the  green  and  most  nutritions  h*avf!8, 
and  buy  it  daily  from  th(!  j)ro(hi(!er,  and  not  from  the  huck- 
ster when  old  and  blanched,  with  94  per  cent,  of  watf;r  and 
but  nine-t(!nths  of  1  ])o.r  (!(Mit.  of  nitrogenouH  material.  On 
such  .substances  nursing-worn(!n  feed  to  make  rich  milk,  and 
puny  babies  are  fed  to  promote  vigor  and  growth.  The  dis- 
agreeable, penetrating,  and  t(!naeions  odor  of  boiling  cabbage 
ought  to  banish  it  from  the  kitchen. 

The  twmip  {Brasdca  napus)  belongs  to  the  cabbage-tribe. 
It  is  les:^  nutritious  than  the  young,  fresh,  green  cabbage,  but 
more  so  than  the  matured  and  blanched  heads. 

Composition  of  the  Turnip  (Letheby). 

Nitrogenous  matter 1.2 

Starch,  etc 5.1 

Sugar 2.1 

Salts 0.6 

Water 91.0 

One  pound  of  turnips  (Smith)  contains  : 

Swede.  White. 

Carbon 30.4  grains.        17.3  grains. 

Nitrogen 15.3      "  11.2      " 

Dr.  H.  C  Bastian,  in  his  experiments  on  spontaneous  gen- 
eration, made  much  use  of  a  solution  of  turnip  as  being  an 
especially  favorable  medium  for  the  growth  of  bacteria  and 
other  microzymes;  and  my  friend,  Dr.  J.  S.  Billings,  U.  S.  A., 
in  repeating  Dr.  Bastian's  experiments,  found  that  bacteria 
developed  more  rapidly  in  a  solution  of  the  turnip  than  in 
any  other  medium  employed  by  him.  This  fact  may  be  of 
but  little  value  as  a  proof  of  the  speedy  deterioration  of  the 
turnip ;  but  in  view  of  other  researches,  as  yet,  perhaps,  not 
determinative  of  any  practical  conclusion,  the  interesting  in- 
quiry presents  itself — ^yhat  relation  does  the  development  of 
bacteria  bear  to  the  degenerative  change  which  vegetables  and 
fruits  undergo,  and  how  far  such  microzymes  may  be  con- 
cerned in  the  causation  of  disease?     Accepting  the  researches 


104  ESSAYS  AND  ADBBESSES 

of  M.  Pasteur  that  "  putrefaction  is  a  fermentation  deter- 
mined by  infusoria  of  the  family  of  vibrios  and  by  bacteria," 
and  the  further  conclusion,  deducible  from  the  researches  of 
M.  Davaine,  that  septic  matter  owes  its  toxic  properties  to 
the  development  of  bacteria,  it  requires  but  little  stretch  of 
the  imagination  to  conceive  how  purulent  iufection  might 
follow  the  introduction  into  the  system  of  bacteria  generated 
during  the  process  of  vegetable  decomposition,  unless  it  be 
maintained  that  such  infusoria  differ  in  their  virulence  from 
those  of  septic  matter.     This  is  but  a  passing  suggestion. 

Like  cabbage,  the  turnip  is  not  easily  digested.  Age  and 
germination  diminish  its  nutritive  quality  and  lessen  its 
digestibility.  As  an  aliment  it  is  less  valuable  than  either 
the  carrot  or  the  parsnip. 

Composition  of  the  Caerot  (Letheby). 

Nitrogenous  matter 1.3 

starch,  etc 8.4 

Sugar 6.1 

Fat 0.2 

Mineral  matter 1.0 

Water 83.0 

"  Ten  grains  of  carrot  (Smith)  when  consumed  in  the  body 
produce  heat  sufficient  to  raise  1.36  pounds  of  water  1°  F., 
which  is  equal  to  lifting  1031  pounds  one  foot  high,"  exceed- 
ing the  power  of  an  equal  amount  of  cabbage  197  pounds, 
and  946  pounds  less  than  an  equal  amount  of  potato. 

Composition  of  the  Parsnip  (Letheby). 

Nitrogenous  matter 1.1 

Starch,  etc 9.6 

Sugar 5.8      ' 

Fat 0.5 

Salts 1.00 

Water 82.0 

The  parsnip  and  carrot  (Smith)  require  from  two  and  a 
half  to  three  and  a  half  hours  to  digest. 

Contrary  to  the  popular  belief,  the  turnip,  carrot,  and  pars- 
nip are  more  easily  digested  and  more  valuable  as  aliments 
than  the  cabbage;   and   it  is  remarkable   that  the   parsnip 


ESSA  YS  A  Nl)  A  DhUKSSKS.  ]  05 

and  CJirrof,  an;  not  inon;  generally  ti.scd.  IJotli  an-  prodiu-- 
tivc  crops,  carry  well,  are  eanily  j)reHervo<l,  and  <lo  ii<»t 
deteriorate  ra|)idly.  When  toii^h  and  fihroim  they  hhoiihl 
be  reje(;te(l.  When  ovcrj^rown  they  ai'e  apt  to  he  hard  in 
the  centre.  The  carrot  is  more  nutritions  in  proj)f)rtion  to 
tliickness  of  the  '^  soft,  outer,  red,  than  the  central,  yelh)\v, 
core-like  i)art. " 

The  cantaloupe  is  especially  illustrative  of  the  rapidity 
of  deterioration,  and  of  the  marked  and  sudden  transition 
from  the  stage  of  perfect  maturity  to  one  of  decay,  and  these 
changes  progress  more  rapidly  if  left,  after  maturity,  attached 
to  the  vine  and  exposed  to  the  air  and  sunlight  than  when 
gathered  and  properly  sheltered.  The  experienced  grower 
knows  precisely  at  what  stage  of  ripening  to  gather  to  suit 
his  method  and  the  distance  of  transportation.  If  distant  a 
night's  journey  in  a  wagon  or  a  few  hours  by  rail  or  water, 
they  can  be  offered  for  sale  in  the  city  in  perfection.  But 
there  is  art  in  growing  as  well  as  tact  in  gathering  the  canta- 
loupe. It  should  be  regular  iu  shape  ;  have  a  well-netted 
and  deeply  furrowed  surface,  and  thick  rind  ;  possess  the 
well-recognized,  penetrating,  and  tenacious  fragrance  ;  and 
be  thick  and  firm  fleshed,  juicy,  and  high  flavored.  Deformed 
and  irregularly  shaped  melons  are  wanting  in  flavor  ;  past 
ripened,  lose  flavor  and  firmness;  insipidity  is  in  proportion 
to  softness  and  pultaceousness.  A  deep-yellow-colored  canta- 
loupe should  not  be  permitted  to  be  sold  in  any  market.  In 
its  highest  state  of  perfection  it  is  delicious,  nutritious,  and 
healthy  fruit ;  in  its  past-ripened,  decaying  coudition  very 
nnwholesome.  No  cantaloupe  in  a  state  of  perfection  to-day 
can  be  kept  in  a  proper  coudition  until  to-morrow  by  any 
process  known  to  me.  The  flattened  aud  blanched  under 
surface  is  always  defective  in  flavor  and  other  essential  quali- 
ties. 

It  may  be  permissible,  though  not  strictly  relevant,  to  refer 
to  the  quality  especially  illustrated  by  this  melon,  which,  as 
expressed  in  ordinary  parlance,  some  fruits  aud   vegetables 


106  ESSAYS  AND  ADDRESSES. 

possess  of  imparting  their  peculiar  aud  characteristic  flavor, 
and  odor  also,  to  certain  oleaginous  articles  of  diet,  when 
packed  together  in  wholly  or  partially  air-tight  compart- 
ments. It  is,  perhaps,  more  properly  the  absorption  by  such 
substances  of  the  volatile  oils  which  give  to  vegetables  and 
fruits  their  aroma ;  and  hence  the  impregnation  of  milk, 
butter,  aud  other  oleaginous  substances  with  the  flavor  of 
certain  fruits  and  vegetables  is  due  to  the  facility  and  extent 
of  such  absorption  of  the  volatile  oils.  How  far  this  may 
affect  the  nutritive  and  digestible  qualities  of  such  articles  I 
do  not  know.  It  may  also  be  added  that  certain  vegetables 
grown  in  near  proximity  reciprocally  impoverish  the  flavor 
of  each — for  instance,  the  squash,  pumpkin,  or  gourd,  grown 
sufficiently  near  the  cantaloupe,  will  destroy  the  flavor  of  the 
latter. 

Fruits.  There  are  a  few  general  observations  applicable 
to  fruits  which  I  may  be  permitted  to  epitomize  from  the 
recent  work  of  Prof.  Pavy  on  Food  and  Dietetics.  Fruit  is 
a  modification  of  the  leaf,  and  in  the  green  state  exhibits 
much  of  its  chemical  composition.  As  maturity  advances 
special  characteristics  develop.  At  first,  like  other  green  parts 
of  the  plant,  the  fruit  absorbs  and  decomposes  the  carbonic 
acid  of  the  atmosphere,  liberating  oxygen  and  assimilating 
the  carbon.  As  the  ripening  progresses  oxygen  is  absorbed 
and  carbonic  acid  given  off,  and  some  of  the  proximate  prin- 
ciples contained  in  the  unripe  fruit,  particularly  the  acids  and 
the  tannin,  in  part  disappear,  apparently  by  oxidation.  At 
the  same  time  the  starch  undergoes  transformation  into  sugar, 
and  the  insoluble  pectose  into  pectin  and  other  soluble  sub- 
stances. In  this  manner  the  fruit  arrives  at  a  state  of  perfec- 
tion. But  as  oxidation  advances  the  sugar  and  remaining  acid 
become  destroyed,  flavor  diminishes,  and  deterioration  sets 
in  ;  and  if  these  changes  are  allowed  to  pursue  their  ordinary 
course,  the  pericarp  undergoes  decay  and  the  seed  is  set  free. 
It  is  thus  manifest  that  the  stage  of  complete  ripeness  is 
quickly  followed    by  degenerative   changes,    which    rapidly 


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108  ESSAYS  AND  ADDRESSES. 

progress  to  the  entire  destruction  of  the  sarcocarp,  unless,  by 
sonae  method  of  preservation,  the  oxidation  can  be  arrested 
at  the  stage  of  ripeness. 

Composition  of  the  Pulp  of  Eipb  Bananas. 

Nitrogenous  matter 4.820 

Sugar,  pectose,  organic  acid,  with  traces  of  starch    .        .       .  19.657 

Fatty  matter 0.632 

Cellulose 0.200 

Saline  matter 0.791 

Water 73.900 

These  analyses  show  that  fruit,  in  consequence  of  the  small 
quantity  of  nitrogenous  matter  and  the  very  large  proportion 
of  water  which  it  contains,  is  not  entitled  to  very  high  rank 
as  a  nutritive  aliment.  "  While  advantageous  (Pavy)  when 
consumed  in  moderate  quantity,  fruit,  on  the  other  hand, 
proves  injurious  if  eaten  in  excess;  of  highly  succulent  na- 
ture, and  containing  free  acids  and  principles  prone  to  undergo 
change,  it  is  apt,  when  ingested  out  of  due  proportion  to  other 
food,  to  act  as  a  disturbing  element  and  excite  derangement 
of  the  alimentary  canal.  This  is  particularly  likely  to  occur 
if  eaten  either  in  the  unripe  or  overripe  state:  in  the  former 
case,  from  the  quantity  of  acid  present ;  in  the  latter,  from 
its  strong  tendency  to  ferment  and  decompose  within  the 
digestive  tract." 

The  cultivated  fruits  are  more  nutritious  than  the  wild,  the 
quantity  of  sugar  being  considerably  augmented,  and  the 
amount  of  insoluble  matter,  skins,  and  seeds  being  greatly 
lessened  by  careful  cultivation.  To  the  succulence  is  due  the 
rapidity  of  degenerative  changes.  Berries  and  cherries  soon 
ferment;  the  latter  even  when  fresh  are  apt  to  disorder  the 
bowels. 

The  strawberry-season  does  not  properly,  in  any  particular 
locality,  extend  beyond  thirty,  but  in  our  northern  cities  it 
not  infrequently  runs  through  sixty,  and  perhaps  even 
ninety,  days.  Since  the  introduction  of  improved  varieties 
and  more  intelligent  culture,  with  careful  gathering  and 
packing    in  small,  open  baskets  in  crates,   favored  by  the 


ESSA  YS  A  ND  A  f) I) U ESSES.  1 09 

rapidity  of  IriinHpoitulioii,  tin;  berries  («in  he  supplied  to  con- 
siuiuirH  iit  L!;i'(^!it('r  distiiiiccH  from  tlio  ]oc;dilicH  whfre  ^rowri, 
in  a  eonditlon  (piito  C(jual  to  the  (h'niand  of  a  ])riidcrit  and 
healtiiy  eonsiiiiiption.  Good  strawberries  slionid  Ix;  plump 
and  firm,  with  ;i  dry  and  nnbroi<en  surface,  and  shoidd  not 
be  S(»parat(!d  from  the  caj)  until  j)repar(!d  for  use.  Rouf^h 
and  unnecessary  handling,  bruising,  moisture,  and  bidk  pro- 
mote feruientation  and  speedy  decay.  Capped  berries  will  not 
long  resist  destructive  change,  aud  neither  bulking  on  the 
salesman's  stand,  nor  sale  by  any  fixed  measure,  should  be 
permitted  in  any  market. 

Strawberries,  like  all  very  small-seeded  fruits,  not  excepting 
the  blackberry,  so  much  valued  by  many  for  its  alleged  astrin- 
gent properties,  are  laxative  in  their  tendency.  The  seeds  are 
absolutely  indigestible,  and  pass  through  the  bowels  unin- 
jured by  the  digestive  fluid.  To  this  quality,  to  their  locally 
irritating  influence  upon  the  mucous  membrane  of  the  alimen- 
tary tract,  aud  to  their  liability  to  cling  to  the  folds  of  and 
find  lodgement  in  the  innumerable  crypts  of  the  membrane, 
add  the  deleterious  influence  of  the  fleshy  part  in  a  state  of 
fermentation  and  decay,  and  surely  nothing  more  is  needed  to 
admonish  you  of  the  danger  of  ingesting  such  deteriorated 
fruit.  These  small-seeded  fruits  are  especially  objectionable 
when  fed  to  young  children,  to  whom  they  are  frequently 
given  during  the  period  when  the  follicular  apparatus  of  the 
digestive  tract  is  undergoing  rapid  evolution,  aud  perhaps  dis- 
turbed in  its  normal  progress  by  some  one  or  more  of  the 
coincident  developmental  operations.  Strawberries  contain 
much  less  insoluble  matter  (seeds  aud  skins),  aud  much  more 
sugar  than  either  the  blackberry  or  raspberry;  carry  better  than 
the  latter,  and  equally  as  well  as  the  blackberry.  The  raspberry 
when  fully  ripe  degenerates  very  soon  and  rapidly  after  being 
gathered  and  packed  for  market,  and  is  very  rarely  offered 
for  sale  before  deterioration  has  commenced.  This  is  due  to 
the  delicacy  of  the  skin  and  the  absence  of  the  caps,  which 
render  it  easily  compressed  by  light  pressure  aud  careless 


110 


ESSAYS  AND  ADDBESSES. 


packing;     It   bears    transportation    badly,    and    only    when 
packed  in  very  small  bulk. 

The  tendency  of  the  berry  family^  to  speedy  fermentation, 
■when  packed  for  transportation,  is  due  to  the  large  propor- 
tion of  free  acid,  structure,  and  delicacy  of  the  skin  which 
does  not  afford  protection  against  injury  from  even  very  light 
pressure  and  very  careful  handling.  This  tendency  is  spe- 
cially manifest  in  the  raspberry  and  mulberry. 

These  analyses  do  not  sustain  the  popular  estimate  of  the 
relative  nutritive  value  of  several  varieties  of  fruits.  The. 
peach  and  apricot,  so  universally  esteemed  because  of  their 
luscious  flavor  and  comparatively  easy  digestion,  are  in  fact 
less  valuable  than  others  less  attractive  and  palatable.  Like 
the  plum  and  the  pear,  they  are  rich  in  pectous  substances, 
which  mask  the  free  acid,  but  do  not  add  much  to  their  ali- 
mentary value.  Wholesomeness  is  not  necessarily  in  propor- 
tion to  the  nutritive  value,  but  to  the  digestibility  and  adap- 
tation to  the  condition  and  wants  of  the  animal  economy. 

In  the  table  below  the  proportions  of  soluble  and  insoluble 
constituents,  and  of  the  seeds  and  skins,  have  been  arranged 
so  as  to  exhibit  with  approximate  accuracy  the  relative  value 
as  aliments  of  the  several  kinds  of  fruit.  The  table  is  based 
upon  the  assumption  that  in  the  soluble  elements  reside,  for 
the  most  part,  if  not  entirely,  the  nutritious  properties.      The 

Pboportions  of  Soluble  and  Insoluble  Constituents. 


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12.0 

12.85 

8.69 

17.24 

9.60 

9.88 

22.37 

U.12 

8.30 

9.64 

8.81 

7.98 

14.03 

9.31 

Insoluble, 

88.0 

87.15 

9L31 

82.76 

90.40 

90.62 

77.63 

88.88 

9L70 

90.36 

9L19 

92.02 

85.97 

90. 69 

Seeds,  skins 

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3.81 

5.95 

5.93 

5.26 

5.61 

2.59 

2.99 

3.94 

L96 

4.10 

5.21 

0.90 

12.86 

1  strawberries,  raspberries,  mulberries,  and  blackberries  are  not  properly  berries, 
though  classed  as  such  here. 


/';,S',S'/1  YS  AND  AI>I>ILI':SSI-:S.  1  1  1 

fie(!(lH  and  .skinn  ar<!  iiiHoliihIc,  and  hut  partially,  if  at  all, 
dij^cstiblc.  Ah  alinientH,  eaoli  kind  muHt  bo  cuuHUh-.ri'A  not 
only  in  reference  to  the  relative  proportion  of  Hfjiuble  and 
in.soluble  constitiKMits,  but  in  rc'2;ard  also  to  tlic  proj)ortion  of 
seeds  and  skins  wliicli  is  neoessarily  invested  with  the  soluble 
and  initritivo  elements.  The  poach  contains  0..'38  })er  cent,  of 
soluble  constituents,  and  5.61  per  cent,  of  seed  and  skin,  but 
the  latter  are  usually  removed  from  the  (idible  portion, 
whereas  the  gooseberry  contains  11.12  per  cent,  of  soluble 
material  and  2.99  per  cent,  of  skin  and  seed,  which,  as  a 
rule,  are  never  removed,  but  ingested  with  the  pulp,  and 
consequently,  while  richer  than  the  peach  in  nutritive  prop- 
erties it  is  less  wholesome,  because  of  these  indigestible  con- 
stituents. The  strawberry  contains  9.64  per  cent,  of  soluble 
elements,  but  1.96  per  cent,  of  seeds  and  skiu  and  1.13  per 
cent,  of  free  acid,  and  must  be  accepted  as  the  healthiest  of 
the  berry  family,  notwithstanding  the  mulberry  is  richer  in 
soluble  constituents  and  contains  but  0.90  of  seeds  and  skin. 
The  large  proportion  of  free  acid  in  the  mulberry  (1.86), 
though  masked  by  2.03  per  cent,  of  pectous  substances,  pro- 
motes speedy  fermentation,  and  even  when  eaten  freshly 
gathered  from  the  tree  this  action  is  set  up,  usually  speedily 
followed  by  some  derangement  of  the  bowels. 

If  the  nutritive  value  of  the  several  varieties  of  fruits  is 
estimated  according  to  the  amount  of  nitrogenous  matter 
(albuminates)  each  contains,  it  is  very  little,  and  would  vary 
between  0.90  per  cent,  found  in  the  cherry  and  0.19  per  cent, 
found  in  the  plum.  The  cherry  and  the  grape  are  richest  in 
nutritive  properties,  in  soluble  constituents,  and  contain  less 
water,  yet  there  is  a  great  difference  in  their  wholesomeness 
as  aliments.  The  grape  contains  but  0.49  per  cent,  of  pec- 
tous substances,  but  is  ingested  without  the  skin ;  the  cherry 
contains  2.28  per  cent,  of  pectous  substances,  and  is  eaten 
with  the  skin  ;  but  the  skin  and  seed  of  the  grape  do  not 
aggregate  more  than  half  of  the  percentage  of  the  skin  and 
seed  of  the  cherry.     Whether  the  difference  in  digestibility 


112  ESSAYS  AND  ADDRESSES. 

is  due  to  the  difference  of  chemical  constitutiou  or  to  the 
parts  ingested  lias  not  been  determined,  but  it  suggests  more 
care  in  avoiding  the  ingestion  of  the  seeds  and  skins  of  fruits. 

Grapes  bear  transportation  well  in  unbroken  bunches,  cher- 
ries badly  at  best,  but  should  never  be  detached  from  the 
stems  until  being  eaten. 

These  examples  are  believed  to  be  sufficient  to  satisfy  you 
of  the  necessity  of  the  inquiry  to  which  I  invite  you  ;  but, 
as  yet,  the  picture  is  far  from  complete.  Before  proceeding 
to  describe  the  process  of  freshening  stale  vegetables  and 
fruits,  now  so  generally  practised  by  market-dealers,  I  must 
briefly  refer  to  the  market- system  in  operation  in  many 
American  cities,  which  I  hold  is  not  only  wrong  in  itself, 
but  productive  of  greater  wrong  upon  the  communities. 

3Iarket-sy8tems.  In  many  of  the  larger  cities  of  this  coun- 
try there  is  a  class  of  dealers,  generally  known  as  "  huck- 
sters," who  stand  between  the  producer  and  the  consumer. 
They  purchase  from  the  producers  fresh  vegetables  and  fruits 
in  large  quantities,  at  prices  far  below  the  rates  paid  by  con- 
sumers, always  overstock  themselves  in  quantity  and  variety, 
preferring  to  carry  over  to  another  market-day  the  surplus 
rather  than  lose  the  opportunity  of  accommodating  a  cus- 
tomer. Having,  by  a  system  of  market-regulations  estab- 
lished by  municipalities  in  their  generous  zeal  to  promote 
business  and  to  foster  trading,  secured,  through  the  payment 
of  a  bonus,  the  right  of  occupancy,  upon  the  payment  of  an 
annual  rental,  of  all  the  stalls  in  the  regular  market-places  al- 
lotted to  the  sale  of  fresh  vegetables,  they  establish  a  monopoly 
so  exclusive  that  the  husbandman  cannot  penetrate  any  nearer 
than  the  nearest  curb-line  or  footwalk,  and  there,  if  at  all, 
offer  his  products  for  sale ;  otherwise  he  must  compete  with 
the  monopolist  at  public  auction,  in  bonus  bidding,  for  a 
suitable  stand  under  shelter.  The  huckster's  capital  consists 
in  his  right  of  occupancy  thus  secured,  perhaps  a  horse 
and  wagon,  and  a  very  small  amount  of  money.  He  pur- 
chases to  sell  and  promises  payment  after  sale.    Competition  is 


ESS  A  YS  A  NJ)  A  I)  DRESSES.  1 1 3 

consequently  noi  IkHvvocm  f  he,  dealers  to  secure  the  choicest  and 
fre8h(!Ht  ))r()(hi(;tH,  hut  hctwccMi  the  growers  to  seenre  a  i)ur- 
chascr.  Far  from  hi.s  <^ar<len  wilh  his  wagoti  and  team,  he 
wisely  submits  to  a  sacrifice  rather  than  return  with  his  per- 
ishahlc  (^)mm()diti('S.  This  hiddin;:;  for  a  purchaser  flofs  not 
enure  to  the  benelit  of  consumers;  it  simply  cnijances  the 
profits  of  the  dealers.  Hucksters  have  little  or  nothing  at 
risk,  and  deal  cxcrlusivcly  for  the  profit;  and  if  supplied 
from  the  surplus  of  the  ])revious  day,  buy  only  to  freshen 
their  wilted  and  decaying  stock.      In  brief,  the  system — 

1.  Regulates  the  supply  by  separating  the  producer  from 
the  consumer. 

2.  Enhances  prices  to  the  consumer,  without  benefiting 
the  producer. 

3.  Compels  consumers  to  purchase  stale,  if  not  deteriorated 
vegetables,  because  the  supply  is  controlled  by  middlemen, 
and  not  by  amount  produced. 

4.  Supply  and  demand  do  not  bear  their  proper  trade 
relationship,  because  supply  can  only  reach  consumers  through 
middlemen  who  control  the  only  channels  of  trade. 

5.  Consumers  cannot  make  quality  a  basis  of  value,  for 
the  good  and  bad  are  mixed.  The  fresh  is  made  to  sell  the 
stale. 

^' Freshening^'  Fruits.  The  system  of  freshening  green 
vegetables  is  extensively  employed  by  many  dealers  in  per- 
ishable vegetables  and  fruits,  and  is  so  cunningly  devised  and 
adroitly  executed  that  it  will  escape  any  but  the  most  careful 
and  cultivated  observation.  It  can  be  most  practially  ex- 
posed by  individual  and  descriptive  illustrations.  Cabbage 
and  lettuce  are  freshened  by  stripping  off  the  external  layer 
of  leaves  and  clipping  the  end  of  the  foot-stalk,  and  this  pro- 
cess is  repeated  from  time  to  time  until  the  head  is  either  sold 
or  is  so  reduced  in  size  as  to  become  unmerchantable.  The 
process  of  stripping  brings  to  the  exterior  the  blanched  and 
whitened  leaves,  and  it  oftentimes  happens  that  the  blanched 
head  most  eagerly  sought  has  been  stripped  sundry  times,  and 

8 


114  ESSAYS  AND  ADDBESSES. 

while  its  surface  is  apparently  fresh  aud  crisp  the  centre  is  in 
a  state  of  decay.  Cabbage  at  certain  seasons  of  the  year  will 
bear  this  process  without  rapid  deterioration;  but  lettuce  is 
much  more  perishable.  Beets,  radishes,  and  other  roots  which 
are  offered  for  sale  bunched,  speedily  deteriorate  in  moder- 
ately warm  weather.  This  begins  first  at  the  circumference 
of  the  leaves,  and  actual  decay  at  that  part  of  the  leaves  and 
midribs  compressed  by  tying,  hence  freshening  is  performed 
by  clipping  or  tearing  off  the  faded  parts,  and  this  process  is 
repeated  until  the  midrib  is  cut  short  to  the  crown,  and  then 
they  are  either  bunched  by  the  extremities  of  the  roots  or 
sold  by  measure,  so  that  not  infrequently  the  fresh  beets 
upon  our  tables  in  May  and  June  have  been  hauled  from 
market  to  market  for  a  week  or  more.  Pease  and  beans  are 
offered  for  sale  bulked  upon  the  market-stand,  and  the  sales- 
man always  measures  from  the  bottom.  The  surplus  from 
previous  sale-days  is  heaped  upon  the  stand,  and  the  entire 
surface  neatly  and  adroitly  covered  with  a  sufficient  quantity 
of  the  more  recently  gathered.  Great  taste  is  displayed  in 
making  the  stale  surplus  look  attractive,  and  much  tact  is 
acquired  in  measuring  so  as  to  disturb  the  surface  but  little 
and  secure  for  the  purchaser  the  full  measure  of  the  under- 
lying deteriorated  legumen.  Spinach  and  kale,  after  the  first 
rush  of  the  season  is  over,  are  generally  so  cheap  as  to  render 
the  freshening  process  unremunerative;  but  when  dear  the 
latter  is  freshened  by  clipping  or  tearing  off  the  faded  parts 
of  the  leaves,  reclipping  the  foot-stalks,  and  sprinkling. 
Spinach  in  cold  weather  can  be  preserved  in  a  fair  condition 
for  some  days.  But  did  it  ever  occur  to  you  that  a  crop 
which  is  left  standing  in  the  open  ground  during  winter 
could  not  be  gathered  in  such  quantities  as  is  sometimes 
offered  in  the  markets  during  hard  weather,  when  the  sur- 
face of  the  ground  is  covered  with  a  foot  of  snow  for  weeks 
and  sometimes  months  ?  The  salesman  will  tell  you  the 
crop  was  protected  with  a  layer  of  straw  or  thick  brush, 
and  by  removing  this  it  was  easily  gathered.     And  so  far 


ESSA  YS  A  Nl)  A  I) DRESSES.  ]  1  f, 

he  tells  tin;  trulli;  I)iil.  if  you  iiii(l(ii:il<(;  lo  rcrnovf!  htniw 
l()().s(;ly  ,s|)r('a(l  upon  the  earth,  and  covered  by  hIx  or  twelve 
inche.s  of  frozcin  snow,  you  will  .soon  l(;arn  it  Ih  far  from  an 
easy  task.  The  truth  is,  thd  crop  is  gathered  before  the 
snow  falls,  ke|)t  in  a  cool,  secure  place,  and  retained  fre- 
quently until  the  price  rules  high. 

"  Unfortunately,  dead  plauts  (Chambers)  do  not  stink  early 
enough  to  disgust  the  nose;  but  yet  every  minute  they  are 
kept  after  their  actual  death — that  is,  after  they  have  ceased 
to  be  capable  of  growth — renders  them  in  some  degree  less 
digestil)le.  Sometimes  they  are  kept  too  long  out  of  mere 
carelessness,  sometimes  from  lack  of  sale,  but  sometimes  also 
intentionally,  to  make  them  look  better  at  table.  For  a  long 
time  I  could  not  make  out  why  London  asparagus  so  often 
disagreed  with  people,  till  at  last  I  caught  a  gardener  cutting 
it  twenty-four  hours  before  it  was  wanted,  and  putting  it  in 
a  damp,  warm  frame,  '  to  swell,'  as  he  said.  Cucumbers  and 
broccoli  are  often  spoiled  in  the  same  way.  The  vast  wagons 
of  cabbage  that  one  sees  coming  into  Loudon  at  midnight  are 
often  the  bearers  of  two  or  three  days'  cutting  in  small  gar- 
dens, kept  till  a  full  load  is  accumulated  for  a  single  journey. 
Sprinkled  with  water  they  look  well,  but  never  regain  their 
fresh  character.  They  ferment  in  the  stomach  and  produce 
flatulence." 

Strawberries,  raspberries,  and  blackberries  are  offered  for 
sale  either  in  bulk  or  in  pint  or  quart  measures  as  trans- 
ported. If  in  bulk,  the  freshening  process  is  executed  in  the 
same  manner  as  other  products  offered  for  sale  in  like  man- 
ner, by  carefully  concealing  the  stale  and  deteriorated  surplus 
from  previous  days  by  a  neatly  arranged  surface,  covering 
with  fresh  fruit  from  the  near  gardens;  and  great  care  is  exer- 
cised in  properly  placing  each  berry,  so  as  to  hide  thoroughly 
the  underlying  fermenting  mass.  If  in  baskets,  the  top  is 
dressed  with  fresh  fruits  and  without  loss  of  measure.  A 
dealer  can  purchase  a  crate  containing  fifty  quart-baskets  of 
strawberries  from  a  producer,  empty  them  upon  his  stand, 


116  ESSAYS  AND  ADDRESSES. 

refill  eacli  basket  by  placing  every  berry,  undersell  the  pro- 
ducer standing  alongside,  and  make  money.  His  baskets 
will  be  "  heaping  full,"  and  each  berry  will  present  a  bright, 
glossy,  fresh  surface  to  the  purchaser,  while  the  producer's 
lot  will  have  sunk  below  the  margins  of  his  baskets,  and 
the  surface  of  the  topmost  layer  of  berries  will  have  lost 
glossiness.     Thus  the  baskets  are  freshened. 

I  may  be  mistaken,  but  my  casual  observations  lead  me  to 
the  conjecture  that  ill-formed  and  defective  fruit  is  fre- 
quently the  result  of  imperfect  and  deficient  fecundation;  and 
I  have  sometimes  thought  we  might  apply  certain  phenomena, 
which  are  constantly  occurring  in  the  vegetable  kingdom,  to 
the  study  and  elucidation  of  the  cause  of  monstrosities  in  the 
animal. 

Certain  conditions  are  essential  to  secure  complete  fecunda- 
tion of  fruit-  and  grain-bearing  plants — sunlight,  a  certain 
amount  of  warmth  and  humidity  of  the  atmosphere,  requisite 
moisture  and  fertility  of  the  earth,  and  adaptation  of  the  soil 
to  the  vegetable  growth.  Cold,  dashing  rains  falling  at  inop- 
portune times,  by  washing  to  the  ground,  and  continuous 
blasts  of  wind,  by  blowing  away  the  pollen-granules,  seri- 
ously interfere  with  perfect  fecundation.  For  instance,  I 
have  seen  two  fields  of  wheat,  each  on  opposite  sides  of  the 
same  road,  or  adjoining,  with  like  exposure,  and  growing 
upon  soil  presenting  no  obvious  differences,  one  yielding 
abundantly,  the  other  but  a  scanty  crop.  The  latter  had 
been  caught  just  at  the  stage  of  full  bloom  by  a  rain  and 
wind  storm ;  the  other  escaped  because  it  was  either  in  ad- 
vance or  behind  its  neighboring  field  in  growth  and  develop- 
ment ;  and,  again,  when  I  have  seen  one  field  yielding  heads 
of  wheat  with  a  full,  plump  grain  for  each  ovum,  and  an 
adjoining  or  other  stalks  in  the  same  field,  springing 
with  other  spears  from  the  same  root,  yielding  heads  with 
light  and  shrivelled  and  absent  grains,  I  have  inferred  that 
in  the  first  fecundation  was  complete,  in  some  incomplete, 
and  in  other  germ-cells  it  failed  entirely.     In  this  suggestion 


ESSAYS  AND  ADDRESSES.  117 

I  iintat^onize  the  ac;(;oj)tc(l  vi(!WH  of  !i^ri(;iilliirlHt.s,  who  ho  gen- 
erally attribute  tlicse  defects  and  faihire.s  alone  to  atrnoHj)heric 
and  (iliniatic!  infliicn(!(!s  ojxTatiii;^  diiriii<r  the  stages  of  devel- 
opment and  ripening. 

Impregnation  of  the  seed-bearing  flower,  or  its  equivalent 
organ,  is  absolutely  ne(;ossary  in  all  grain-bearing  plants,  or 
else  the  product  will  be  a  failure.  When  single  spears  of 
corn  stand  alone  the  ears  never  fill,  because  the  pollen  from 
the  top-gallant  fails  to  reach  every  germ-cell  through  the  silk; 
and  if  two  rows  of  corn,  each  of  a  distinct  variety,  be  planted 
alongside,  every  ear  will  contain  grains  of  both  varieties  more 
or  less  distinctly  marked;  but  if  from  any  cause  any  part  of 
the  silk  of  an  incipient  ear  be  destroyed  previous  to  fecun- 
dation, no  grains  will  be  developed  in  the  cells  connecting 
with  such  injured  silk;  and  imperfect  impregnation  will  find 
many  illustrations  in  the  ill-formed  and  defectively  devel- 
oped grains. 

All  flowers  are  sexual,  being  furnished  with  the  fertilizing 
or  fertile  organs,  or  bisexual,  possessing  both  stamens  and 
pistils,  varying  in  number  from  a  single  stamen  and  pistil  to 
any  indefinite  number  of  each.  In  all  fruit-bearing  plants 
complete  fecundation  is  essential  to  the  perfection  of  the  seed; 
and,  as  it  is  a  rule,  with  but  few  exceptions,  that  a  full  devel- 
opment of  the  sarcocarp  is  concurrent  with  complete  maturity 
of  the  seed,  it  is  manifest  that  the  perfection  of  the  latter,  like 
the  perfection  of  the  seed,  must  depend  upon  proper  fecunda- 
tion. The  first  dropping  of  young  fruit,  which,  even  after  an 
abundant  show  of  blossoms,  sometimes  extends  to  the  whole 
orchard  crop,  is,  says  Watson,  mainly  due  to  the  imperfec- 
tion or  total  failure  of  the  fertilization,  whether  this  arises 
from  drought  and  glaring  sunshine,  from  unseasonable  cold, 
an  inopportune  storm,  or  from  other  less  manifest  causes  :  all 
such  dropped  fruit  is  seedless  or  germless.  Again,  as  it  will 
occasionally  happen,  a  fruit  grown  among  a  number  upon 
the  same  tree  will  be  seedless,  and  invariably  such  a  fruit 
will  be  deficient  in  development — if  not  ill-formed,  certainly 


118  ESSAYS  AND  ADDRESSES. 

diminutive  in  size.  Neither  the  cucumber  nor  the  cantaloupe 
will  fructify  under  glass,  except  by  the  actual  and  artificial 
contact  of  the  staminate  with  the  pistillate  flower,  even  though 
the  requisite  conditions  of  humidity,  temperature,  sunlight, 
adaptation  of  the  soil,  and  vigorous  growth  may  all  be  pres- 
ent. The  plants  are  monoecious,  and  the  sexually  distinct 
blossoms  grow  in  near  proximity,  yet  the  crop  will  prove  a 
signal  failure  unless  artificial  impregnation  is  carefully  exe- 
cuted ;  and  this  is  true  of  all  fruit-bearing  plants  unless  the 
fruit-bearing  blossom  is  bisexual.  Hence  it  is  evident  that 
some  condition  which  pertains  exclusively  to  the  open  air 
is  essential  to  complete  fecundation  in  the  monoecious  and 
dioecious  plants. 

The  strawberry-plant  presents  itself  in  distinct  staminate 
and  pistillate  varieties,  and  with  bisexual  flowers.  If  you 
destroy  in  irregular  patches  the  pistils  projecting  in  great 
numbers  from  the  posterior  surface  of  the  ovum  of  a  pistil- 
late variety,  or  in  like  manner  occlude  the  stile-tubes,  each 
one  of  which  communicates  with  a  germ-cell,  and  leave  the 
undisturbed  pistils  and  stile-tubes  in  near  proximity  to  a 
staminate  flower,  those  parts  of  the  fruit  will  fecundate  and 
develop  to  maturity,  whereas  the  parts  connecting  with  the 
destroyed  pistils  or  occluded  stile-tubes  will  remain  undevel- 
oped, and  the  fruit  as  a  whole  will  be  ill-shapen  and  de- 
formed. Most  of  our  fruit-bearing  trees  have  perfect  bisexual 
blossoms,  with  more  than  one  stamen  and  a  number  of  pis- 
tils, hence,  reasoning  from  analogy,  I  have  reached  the  con- 
clusion that  knotty,  irregularly  shapen,  and  defectively  de- 
veloped apples,  pears,  peaches,  and  other  fruits,  result  from 
defective  and  imperfect  fecundation. 

If  these  sug-gestions  and  observations  are  entitled  to  con- 
sideration,  and  worthy  of  being  classed  as  facts,  surely  I  have 
established  the  proposition  that  defective  development  in  fruits 
is  in  a  measure  due  to  imperfect  fecundation.  I  shall  not,  at 
present,  undertake  to  estimate  their  value  in  determining  the 
nature  and  causes  of  the  degenerative  changes  which  speedily 


ESS  A  YS  A  NI)  A  f>  DRESSES.  119 

take  |)la(!(',  in  frcsli  fniifs,  rutr  tlio  cSfcct  (tf  sufli  iinporfoctly 
(l(!V('loj)e(l  fruits  wlicn  coiiHiuucd  ;iH  food. 

Tlie  final  con.sidorations  relate  exeln.sivcly  to  the  remedy 
for  the  imposition  praetised  in  the  sale  of  fresh  vegetables  and 
fruits.  A  system  of  competent  inspection  will  undoubtedly 
accom])lish  nuicli  and  correct  many  of  the  alleged  abuses; 
and  not  only  must  the  plan  be  wisely  regulated,  but  the 
officials  must  be  ])ersons  skilled  in  the  art  of  gathering  and 
packing  and  in  the  trans|iortation  of  perishable  fruils  and 
vegetables.  No  mere  novice  who  has  passed  a  lounging  life 
in  a  city,  absolutely  ignorant  of  the  essential  qualities  of 
fresh  fruit  and  vegetables,  too  weak  to  resist  temptation,  and 
too  timid  to  discharge  fearlessly  a  disagreeable  duty,  would 
accomplish  any  good.  To  this  must  be  added  the  right  of 
confiscation.  The  enormity  of  the  crime  must  be  brought 
directly  home  to  the  practical  and  pecuniary  necessities  of  the 
offender.  The  business  of  huckstering  can  be  conducted  in  a 
proper  manner  with  profit,  and  I  would  rather  not  believe 
that  every  man  engaged  in  the  business  resorts  to  the  tricks 
of  the  trade. 

But  the  most  effectual  means  for  the  accomplishment  of 
satisfactory  results  will  be  the  establishment  of  free  market- 
places for  the  accommodation  of  the  producers.  Afford  ample 
opportunities  for  the  utilization  of  the  products  of  his  labor, 
and  cease  compelling  him  to  sink  his  scanty  earnings  in  the 
enormous  profits  of  middlemen.  The  perishable  products  of 
the  farm  are  introduced  into  cities  for  immediate  consump- 
tion, and  every  obstacle  which  obstructs  the  ready  access  of 
the  consumer  to  the  producer  should  be  removed,  and  munici- 
palities should  abandon  such  sources  of  revenue.  Thus  may 
value  be  enhanced  to  the  producer  and  diminished  to  the  con- 
sumer.     Quality  will  be  improved  and  health  promoted. 


120  ESSAYS  AND  ADDRESSES. 


OBSTETRICS  AND  DISEASES  OF  WOMEN  AND 
CHILDREN. 

ADDEESS    IN    OBSTETRICS    AND    DISEASES    OF    WOMEN    AND 

CHILDREN,    DELIVERED    BEFORE    THE    AMERICAN 

MEDICAL  ASSOCIATION  AT    PHILADELPHIA, 

JUNE  8,  1876. 

Mr.  President  and  Gentlemen  :  The  written  law  of 
this  Association  limits  this  address  to  the  discussion  of  the 
''advances  and  discoveries  of  the  past  year"  in  obstetric, 
gynecic,  and  paediatric  medicine. 

However  willing  or  coaipetent  I  might  be  to  fill  the  meas- 
ure of  this  requirement,  the  time  allowed  me  would  necessa- 
rily preclude  a  critical  examination  of  all  the  contributious  to 
this  department.  Nor  would  this  be  desirable,  since  many  of 
them  are  mere  novelties  of  little  or  no  value  or  hasty  promul- 
gations of  immatured  opinions  and  illogical  conclusions. 

The  recent  literature  of  this  department  of  medicine  may, 
not  inaptly,  be  compared  to  a  sheaf  containing  many  heads 
of  wheat ;  some  with  each  capsule  filled  with  a  perfectly  devel- 
oped, matured,  and  ripened  grain,  rich  in  the  elements  essen- 
tial to  its  production  in  kind.  Other  heads  contain  light  and 
shrivelled  grains,  the  yield  of  an  impoverished  or  ill-cultivated 
soil,  which,  while  not  wholly  valueless,  yet  nevertheless  are  far 
below  the  proper  standard  in  weight  and  measure,  not  unfit  for 
ordinary  consumption,  but  unworthy  of  preservation,  and  pro- 
gressively degenerating  by  reproduction.  Lastly,  other  heads 
there  are  with  empty  capsules,  destitute  of  a  single  fecundated 
ovum,  containing  nothing  but  chaff,  mere  abortions  ab  initio. 
To  winnow  out  the  chaff  would,  perhaps,  be  but  a  work  of 
time,  intelligently  and  assiduously  employed  ;  but  to  glean 
from  the  entire  mass  only  the  perfect  grains  and  to  estimate 
the  value  of  each  demand  a  degree  of  accuracy  only  to  be 


ESSA  YS  A  NI)  A  DDRKSSKS.  1  2 1 

acquired  by  ujroat  experience  an<l  an  iiiii)arti;il  jndj^ment. 
Even  more  Ih  re(|iiire(l  to  dctoniiiiu;  ooncctly  what  are  the 
'^  advances  and  discoveries"  in  these  branches  of  medical 
science,  for  every  such  chiim  must  be  submitted  to  the  ruth- 
less arbitrament  of  time  and  be  verified  by  the  repeated 
observations  of  skilled  specialists. 

Obstetricians  are  pr<)verl)ially  slow  either  to  seek  or  to 
accept  new  things.  The  maxim  of  Blundell  even  yet  im- 
presses the  medical  mind,  and  the  groat  master,  though  re- 
tired from  active  pursuits,  is  still,  in  spirit,  present  at  every 
accouchement,  sounding  the  tocsin  of  alarm,  "  meddlesome 
midwifery  is  bad;"  and  this,  while  it  inspires  some  with 
awe,  lest  by  some  inadvertence  they  transgress  the  canons 
prescribed  by  him  and  others  of  equal  renown,  has,  fortu- 
nately for  suffering  women,  encouraged  others  to  seek, 
through  careful  study  and  more  careful  observation,  in  this 
devious  path  of  scientific  research,  additional  aids  by  which 
the  sphere  of  active  interference  in  the  management  of  ab- 
normal labors  may  be  extended,  the  suffering  of  parturition 
diminished,  and  its  dangers  averted. 

To  this  end  Goodell  has  devised  a  method  of  utilizing 
power  in  the  delivery  of  'Miead-last "  labors  with  safety  to 
both  mother  and  child,  by  rendering  effective,  through  con- 
joint, suprapubic  propulsion  and  "  movements  of  unremitting 
traction  "  on  the  foetal  neck,  the  minimum  of  traction  force. 
This  mode  of  delivery  necessarily  depends  on  "  the  tensile 
strength  of  an  infant's  neck,"  and  the  operator  must  accept 
the  alternative  of  '^  killing  in  the  attempt  to  save,  ratiier  than 
of  killing  by  cowardly  inaction."  The  force  employed  should 
not  exceed  the  minimum  of  power  requisite  for  decollation. 
The  spinal  column  may  snap  under  a  weight  of  105  pounds, 
the  soft  parts  yielding  under  a  weight  of  120  pounds. 

Duncan  concludes,  from  his  recent  experiments  upon  the 
fresh  cadavers  of  adult  fceti,  that  the  power  admissible  in 
extraction  by  the  feet  cannot  safely  exceed  the  force  of  100 
pounds,  which  is  adverse  to  podalic  version  in  narrow  pelves; 


122  ESSAYS  AND  ADDRESSES. 

but  in  original  breech  presentations  and  footlings  the  alterna- 
tive is  not,  as  a  rule,  between  podalic  and  forceps  extraction, 
for  the  procedure  relates  exclusively  to  the  completiou  of  de- 
livery by  traction  on  the  neck  of  a  foetus  partially  extruded. 
And  surely,  in  view  of  the  mortality  of  breech  presentations, 
even  in  the  practice  of  specialists  of  unrivalled  dexterity,  the 
ipse  dixit  of  a  bygone  period  should  uot  deter  the  obstetri- 
ciau  from  efforts  to  employ  this  power  to  the  best  mechanical 
advantage.  The  method  of  Goodell  is  an  advance  in  the 
right  direction,  and  the  hope  may  be  cherished  that  we  may 
hereafter  "  approach  a  case  of  head-last  labor  with  an  assur- 
ance of  success  such  as  we  never  had  before." 

Not  less  valuable  and  original  is  the  procedure  of  the  late 
Dr.  John  S.  Parry,  in  which  the  hand  is  employed  "  to  flex 
the  head  when  partially  extended  in  all  its  presentations,  to 
transform  occipito-posterior  into  occipito-anterior  positions, 
and  to  change  presentations  of  the  face  with  the  chin  behind 
into  those  of  the  vertex  with  the  occiput  in  front."  These  ma- 
nipulations, doubtless  more  easily  demonstrated  in  the  lecture- 
room  than  executed  on  the  living  subject,  supply  aids  for  the 
conversion  of  some  abnormal  labors  into  natural  ones,  facili- 
tate the  application  of  the  forceps  in  certain  cases,  and  expe- 
dite delivery  in  difficult  cases  of  craniotomy.  Dr.  Parry 
enjoins  '^  absolute  certainty  of  diagnosis,"  only  to  be  secured 
by  the  "  introduction  of  the  whole  hand  into  the  vagina" — 
a  resource  which  should  never  be  omitted  in  case  of  doubt. 
More  recently  Penrose  has  suggested  a  method  of  hastening 
delivery  in  mento-anterior  positions  of  the  face  by  establish- 
ing a  force  of  artificial  resistance  to  the  posterior  cheek  of  the 
foetus,  whereby  rotation  of  the  chin  is  promoted. 

Dr.  George  Johnston's  successful  application  of  the  forceps 
to  cases  of  undilated  but  dilatable  os  uteri  is  a  practical  nega- 
tion of  another  of  the  traditional  canons,  and  constitutes  an 
epoch  in  the  history  of  obstetrics.  He  adapts  such  interfer- 
ence to  cases  ^'of  early  rupture  of  the  membranes  "  and  escape 
of  the  "  liquor  amnii  before  dilatation  of  the  os;"  to  cases 


ESSA  YS  A  Nl>  A  DDIiHSSHS.  1  2;i 

wlicrc!  tlu!  mcinbrjiMcs  iiic  ('iitirc,  and  \\\v.  licat!  liuH  dcw^crxlifl 
on  tlic  (iorvix  without  the  intervention  (jf  the  bag  of  waters, 
"  and  (!X'|)!Uidin<^  it,  thcixihy  piv^ssiiig  as  iiijurioii.sly  iipoti  it 
as  if  th(!  liquor  atnnii  had  cHcajXMl  ;"  to  caso.s  fotnphcatod  witli 
prolapse  of  the  funis;  and  to  cases  of  partial  placenta  praevia. 
This  operation  is,  perhaps,  inadmissible  in  eases  where  the 
extent  of  dilatation  has  not  reached  two-fifths  (one  and  five- 
eighths  inches),  but  is  an  encouraging  resource  whether  the 
head  is  above  or  within  the  brim  or  has  descender!  into  the 
cavity  of  the  pelvis,  and  is  not  less  illustrative  of  the  life- 
saving  power  of  the  instrument  than  of  its  value  in  shorten- 
ing the  duration  of  labor.  But  while  thus  the  capacity  of 
the  forceps  as  a  tractor  is  being  extended,  its 'double-lever 
power  is  being  discarded.  Only  recently  Duncan,  in  an 
elaborate  essay  which  has  been  commended  by  Keiller,  Mac- 
douald,  Simpson,  Young,  Bruce,  and  others,  has,  with  his 
tisual  vigor  and  directness,  portrayed  the  dangers  of  the 
*'  pendulum  movement  of  the  midwifery  forceps,"  and  in- 
sisted that  it,  like  other  honored  relics  of  the  past,  should  be 
dismissed  from  service. 

The  fact  cannot  escape  your  observation  that  these  innova- 
tions, born  of  thoughtful  study,  have  emanated  from  men  of 
large  experience  and  unsurpassed  dexterity,  who  have  been 
favored  with  unusual  advantages  and  a  sound  and  intuitive 
judgment.  Such  advantages  do  not  come  to  every  accoucheur, 
but  all  can  emulate  their  example  and  profit  by  their  triumphs. 

Among  the  mechanical  aids  recently  devised,  Dr.  Poullet 
has  projected  an  apparatus  denominated  ''  the  sericeps,"  for 
which  he  claims  advantages  in  certain  cases  of  dystocia  supe- 
rior to  the  ^^  steel,  of  Chamberleu." 

This  new  device  is  made  of  a  seamless  material,  woven 
double,  having  the  maximum  of  solidity.  It  consists,  first, 
of  a  transverse  baud  intended  to  be  spread  around  the  fojtal 
head,  its  two  extremities  being  connected  by  cords  of  silk  laced 
through  eyelets.  These  cords  are  loose  when  the  band  is  being 
adjusted,  and  when  drawn  should  close  the  transverse  band 


124  ESSAYS  AND  ADDRESSES. 

around  the  cranial  ovoid  along  its  suboccipito-malar  circle. 
Second,  of  four  ribbons  inserted  along  the  entire  inferior  bor- 
der of  this  band,  and  united  at  the  other  extremities,  two  by- 
two,  forming  two  handles,  by  which  traction  is  made.  The 
apparatus  is  adjusted  by  means  of  three  arms  introduced  be- 
tween the  uterus  and  foetal  head,  superposed  one  upon  the 
other,  in  the  sheaths  formed  by  the  ribbons,  and  when  car- 
ried up  to  the  promontory  of  the  sacrum  are  separated,  the 
posterior  branch  remaining  in  position,  and  "  the  other  two 
by  a  movement  of  rotation  are  carried  along  the  sides  of  the 
head  until  they  meet  in  front  above  the  arch  of  the  pubis,, 
when  the  cords  are  drawn,  the  mental "  arms  removed,  and 
extraction  begun  by  traction  upon  the  ribbon  handles. 

If  the  circle  has  been  placed  sufficiently  high  upon  the 
ovoid,  it  grasps  a  zone  of  smaller  diameters  than  the  central, 
so  that  the  material  being  inelastic  when  traction  is  made,  "  it 
cannot  descend  until  the  cranial  ovoid  is  drawn  before  it."  If 
carried  up  to  the  chin  or  neck  of  the  child,  the  circle  is  closed 
and  gentle  traction  upon  the  ribbon  handles  adjusts  the  band 
to  the  cranial  ovoid. 

Dr.  Poullet  claims  ''that  in  all  cases  requiring  energetic 
traction,  particularly  in  the  superior  strait,"  this  instru- 
ment will  diminish  the  mortality  of  children  while  better 
protecting  the  soft  parts  of  the  mother,  and  insists  that  its 
superiority  over  the  forceps  consists  in  the  inappreciable  vol- 
ume added  to  the  child's  head  ;  its  easy  application  to  cases 
of  long  and  painful  labor  ;  the  pliability  of  the  ribbons,  which 
free  the  soft  parts  from  violent  pressure  ;  the  absence  of  local- 
ized compression  of  the  brain  and  of  any  imprint  upon  the 
head ;  its  affording  means  of  prehension  without  lateral 
pressure;  the  firmness  of  the  grasp,  which  never  slips;  the 
increased  range  permitted  to  the  movements  of  rotation  ;  and 
its  harmlessness,  however  long  permitted  to  remain  in  posi- 
tion, thus  in  all  of  its  actions  resembling  "  physiological 
labor."  It  is  also  more  easily  and  certainly  applied  in  the 
rare  cases  of  decapitation,  affords  greater  opportunity  for  the 


ESSA  YS  A  NI)  A  I)  l> It  ICSSES.  ^  25 

operation  of  perforation,  iuid  (^onlriltiilcs  v;ilii;il)l(!  aid  in  cvac- 
uatinii;  tlu;  craniid  cavity  after  perforation. 

The  inventor  refers  to  Manricean'H  idea  of  a  sort  rtf  .sling 
or  bandage,  vvliieii  wan  nev(!r  a|)j)lied;  to  Arn:;nid'.s  de^sorip- 
tion  of  a  eapof  thread  to  he  adjiist(;(l  to  the  h(,'ad  aft(!r  deeapi- 
tation;  and  to  Mead's  Jiandle  or  golf  of  .soft  material,  to  be 
inserted  with  a  whalebone  between  the  chin  and  chest,  whioh 
Smellio  tried  to  use,  but  finally  abandoned;  and  coneludo.s  his 
review  with  the  assertion  ''  that  at  the  present  day  there 
exists  no  pb'able  means  capable  of  taking  hold  of  the  head 
when  engaged  in  the  pelvis  and  of  exercising  upon  it  sufficient 
traction  to  complete  labor." 

The  merit  and  originality  of  this  invention  belong  to  an 
American  physician.  As  long  ago  as  1851  Dr.  John  Evans, 
of  Chicago,  published  a  description  of  his  "  Obstetrical  Ex- 
tractor," and  he  had  previously  reported  in  the  Transactions 
of  this  Association  for  1850  five  cases  in  which  he  had  suc- 
cessfully applied  the  apparatus.  Subsequently,  in  1852,  he 
published  another  series  of  twelve  cases,  some  of  which  were 
in  consultation  with  Prof.  N.  S.  Davis. 

Nor  is  this  all.  The  descriptions  of  the  two  inventions — 
one  in  the  English,  the  other  in  the  Fi'ench  language — are  so 
nearly  identical  that  it  is  not  easy  to  believe  the  latter  could 
have  been  written  without  previous  knowledge  and  examina- 
tion of  the  former ;  yet  the  latter  was  submitted  to  the  Sur- 
gical Society  of  Lyons  and  referred  to  a  committee  of  distin- 
guished physicians  as  an  original  description  of  a  new  instru- 
ment. 

The  genius  of  our  French  inventor  has  found  further 
opportunity  for  development  in  an  attempt  to  utilize  and 
regulate  mechanical  traction,  by  adapting  the  principle  of  the 
"  windlass  or  capstan  "  to  extraction,  thus  substituting,  it  is 
claimed,  ^'  a  sustained  and  graduated  mechanical  force  for  the 
irregular  muscular  efforts  of  the  operator."  Dr.  Poullet  con- 
cedes the  original  idea  to  his  compeer,  Joulin,  claiming  only 
to  have  transferred  the  point  of  support  from  the  perineum 


126  ESSAYS  AND  ADDRESSES. 

to  the  tuber  ischii,  which,  he  maiutaius,  will  bear  the  pressure 
of  the  traction  force  without  iujury. 

The  inventor  claims  to  have  realized  the  following  condi- 
tions: "  True  and  uniformly  sustained  traction,"  by  making 
the  pelvis  of  the  woman  the  point  of  support. 

Greater  opportunity  for  making  traction  "  in  the  various 
directions  useful  iu  the  differeut  stages  of  labor." 

Increased  facility  for  the  application  of  force  without  re- 
straining the  movements  and  position  of  the  lower  limbs. 

Obtaining  support  from  the  ischii  without  pain  and  with- 
out interfering  with  the  use  of  the  cords  or  "  forceps  or  de- 
livery by  the  hand," 

These  conditions,  the  author  claims,  present  advantages 
superior  to  Chassagny's  apparatus,  which  derived  its  point 
of  support  from  the  knees;  to  Tarnier's  ^'tackle  and  pul- 
ley," which  has  for  its  point  of  resistance  a  neighboring 
plauk ;  to  Hamon's  apparatus,  which  is  supported  by  two 
crutches  resting  on  the  genito-crural  folds  of  the  patient ;  to 
Pros's  invention,  in  which  the  point  of  resistance  "  was  a 
wooden  frame  placed  under  the  seat  of  the  patient ;"  or  to 
Joulin's  ' '  aid-forceps,"  which  rest  upon  the  soft  parts  of  the 
perineum.  Its  practical  merits  cannot,  however,  be  estab- 
lished by  its  comparative  advantages  over  all  previous  devices 
to  multiply  force.  It  is  questionable  whether  such  multipliers 
of  force  can  be  utilized  in  dragging  a  foetus  through  the  bony 
channel  without  serious  injury  to  both  mother  aud  child  or 
be  made  a  substitute  for  the  traction  and  compression  powers 
of  the  forceps. 

In  such  case  the  power  driving  the  foetal  head  downward 
and  the  power  dragging  it  forward  through  the  pelvic  cavity, 
together  with  the  counter-force  acting  upon  the  ischial  tuber- 
osities, would  be  expended  upon  the  framework  of  the  maternal 
passage,  for  the  true  pelvis  would  present,  at  its  superior 
strait  or  within  its  cavity,  the  obstacle  to  delivery,  and,  at 
the  same  time,  at  the  termini  of  the  transverse  and  shortest 
diameter  of  the  outlet,  the  points  of  counter-resistance  would. 


hSSA  VS  AND  AnnnESSKS.  ]27 

no(!0,s8arily,  he  alwayn  equal,  an<],  flioiif>;li  aetinj^  in  oj)p(iHito 
directions — tlie  lir.st  through  the  we(l}^(!-lik(!  power  ol'th*!  fo-tal 
head  and  the  latter  iij)on  the  tiihiT  iH(!hii,  tran.srnitted  ahnig 
the  ischial  rami — would  he  expended  upon  the  pelvic  nyu- 
chondroscH,  |)erlia|).s  not  often  di.stiiroin<r  tiicHc  atfaehnienfH, 
but  certainly  Kuhjeetinj:^  them  to  doul)l(!  the  force  required  in 
forceps  extraction.  Plence,  apart  from  (Ik;  fact  that  auto- 
matic movements  cannot  intellijjjently  supply  the  muscular 
power  and  manual  dexterity  of  the  skilled  ohstetrician,  it 
seems  essential  that  all  traction  force,  by  whatever  mechan- 
ical instrument  su{>plic(l,  must  be  free  from  and  independent 
of  any  counter-pressure  upon  the  pelvis  of  the  mother. 

The  discussion  on  the  employment  of  perchloride  of  iron 
in  post-partum  hemorrhage  has  vindicated  its  value  as  a  styp- 
tic and  established  its  efficacy  in  those  emergencies  in  which 
all  things  else  seem  to  fail;  but  the  fact  remains  undisturbed 
that  complete  and  persistent  uterine  contraction  is  the  one 
thing  which  assures  haemostasis. 

Closely  allied  to  this  subject  is  the  operation  of  transfusion. 
The  recent  successful  employment  of  milk  by  Prof.  T.  G. 
Thomas,  while  it  presents  nothing  new  either  in  surgical  exe- 
cution or  in  the  nature  or  preparation  of  the  fluid  employed, 
is  yet  in  its  mere  success  a  contribution  to  science,  and  adds 
assurance  of  the  ultimate  acceptance  of  the  procedure  as  an 
imperative  recourse  in  needful  cases. 

The  transfusion  of  milk  was  first  successfully  accomplished 
by  Hodder  in  1850,  in  two  or  three  cases  of  cholera-collapse. 
Previously,  however,  Donne  had  injected  milk  into  the  veins 
of  dogs  and  rabbits  without  injury  to  the  animals;  and  sub- 
sequently (1854)  Herapath,  following  Richardson's  previously 
suggested  treatment  of  cholera-collapse  '^  by  the  artificial  pro- 
duction of  peritoneal  or  cellular  dropsy,"  advocated  injections 
of  milk  or  of  milk  and  water  into  the  peritoneal  cavity,  cellular 
tissue,  or  venous  system  in  similar  conditions.  Waggstaffe, 
in  1872,  made  two  unsuccessful  attempts — one  with  con- 
densed milk  in  a  case  of  "  extensive  hemorrhage  "  following 


128  ESSAYS  AND  ADDRESSES. 

amputation  of  both  legs  below  the  knee,  the  other  with  con- 
densed milk  and  defibrinated  blood  ;  and  Howe's  experiment 
with  goat's  milk,  in  1874,  in  a  case  of  tubercular  disease, 
proved  equally  unavailiug. 

As  yet,  the  elevation  of  temperature,  which  is  one  of  the 
most  constant  and  perhaps  the  most  important  phenomenon 
following  transfusion,  has  not  been  explained.  In  Wagg- 
staffe's  case  it  rose  2.8°  in  three  hours  (taken  in  the  vagina), 
and  in  Thomas's  case  it  rose  in  one  hour  to  104°.  This  py- 
rexia has  been  attributed  to  an  extra  absorption  of  the  pro- 
ducts of  tissue-change;  to  absorption  of  pus  from  the  wound; 
to  accumulation  of  blood  in  the  portal  system  ;  to  the  intro- 
duction of  a  different  sort  of  blood  or  of  a  fluid  differing  in 
nature  and  density ;  to  the  destruction  of  the  constituents  of 
the  blood,  and  to  molecular  disturbance ;  but  none  of  these 
hypotheses  has  been  adopted. 

Fr^se  concluded  from  his  experiments  that  the  transfusion 
of  a  small  quantity  of  blood  would  not  produce  an  appreci- 
able amount  of  fever;  but  that  a  large  quantity,  if  preceded 
by  bleeding,  was  always  succeeded  by  fever.  Albert  and 
Strieker  transfused  into  healthy  animals  their  own  blood  by 
letting  it  flow  directly  from  the  femoral  artery  into  the  fem- 
oral vein  of  the  same  side,  and  each  time  fever  resulted. 
Billroth  repeated  these  experiments,  but  failed  to  obtain  the 
same  results.  Leibrecht  concludes,  from  similar  experiments 
recently  repeated,  that  an  elevation  of  temperature,  repre- 
sented by  2°  Centigrade,  may  result  from  the  simple  transfu- 
sion of  blood,  and  fever,  if  occurring  at  all,  will  always  occur 
within  three  hours  after  the  completion  of  the  operation.  In 
Hiitter's  cases  of  arterial  transfusion  with  defibrinated  human 
blood,  and  in  Ewald's  cases  with  the  defibrinated  blood  of  per- 
sons suffering  from  bronchitis,  fever  ensued.  Fever  resulted 
in  all  of  the  cases  of  Hasse  and  Thurn,  who  employed  defi- 
brinated lamb's  blood.  Kuster  had  no  unpleasant  symptoms 
with  human  defibrinated  blood,  but  fever  and  other  unpleasant 
phenomena  in  a  case  in  which  lamb's  blood  was  used.   Nicholas 


ESSAYS  AND  A  DIHIHSSKS.  ]  2fi 

Diiranty'H  experirncntH  on  anirnalH  with  fvtrjlcd  Mfjod  were 
entirely  HiitisfjuMoi'y.  The  ni.searehcH  of  Ponfir;l<  and  I/itu]r>iH 
seem  to  h'.ivc;  established  the-  <lel(!t(!riou.s  infliierieeH  of  the 
introduction  of  th(!  hlood  of  different  specicH  in  producing 
disintegration  of  the  red  blood-oorpuHeleH  and  .setting  free 
hicni()<;lobin,  which  can  ordy  be  eliminated  by  the  kidneyH. 
These  facts,  together  with  the  additional  observation  of  Ijan- 
dois  that  eopioiis  transfusion  produces  massing  of  the  blorKl- 
cells,  which  tends  to  extensive  (coagulation,  and  the  more 
recent  demonstration  by  Panum  that  an  extra  supply  of  red 
blood-corpuscles  involves  an  additional  consumption  of  oxy- 
gen, and  that  heat  is  evolved  by  their  oxidation,  may  furnish 
the  key  by  which  this  problem  may  be  solved. 

These  results,  both  clinical  and  experimental,  seem  to  estab- 
lish the  hremic  origin  of  the  fever.  Yet  the  not  unusual 
occurrence  of  other  phenomena  denoting  "  disturbance  of  the 
functions  of  innervation  and  circulation;"  the  sudden  and 
rapid  ascent,  and,  in  successful  cases,  the  equally  rapid  de- 
scent of  the  temperature,  suggest  the  probable  co-operation 
of  a  neurotic  element,  to  which  attention  has  been  recently 
directed  by  Dr.  H.  C  Wood,  Jr.  The  doctrine  is,  however, 
not  universally  accepted  that  deviation  of  body-temperature 
and  fever  are  synon^-mous.  This  source  of  error  can  only  be 
eliminated  by  more  thorough  and  carefully  recorded  clinical 
histories. 

The  clinical  and  experimental  observations,  apart  from  the 
accidents  incident  to  the  formation  of  coagula ;  the  convey- 
ance of  emboli  into  the  general  circulation;  the  introduction 
of  air ;  the  too  rapid  repletion  of  the  right  side  of  the  heart ; 
and  the  injurious  effects  upon  the  blood-mass,  favor  the  con- 
clusion that  the  chief  cause  of  failure  and  death  lies  in  the 
febrile  phenomena,  which  are,  perhaps,  proportionate  to  the 
amount  of  fluid  transfused,  enhanced  by  any  pre-existing 
fever  or  previous  hemorrhage,  and  the  neglect  of  this  febrile 
condition  in  the  subsequent  management  of  the  case.  Hence 
it  is  that  the  largest  percentages  of  recoveries  have  been  in 

9 


130  ESSAYS  AND  ADDRESSES. 

those  cases  iu  which  there  was  a  previous  redaction  of  tem- 
perature and  in  those  uncomplicated  with  pre-existing  pyrexia 
or  subsequent  irritative  fever,  as  iu  cases  of  surgical  hemor- 
rhage. 

Defibrinated  human  blood  and  milk  are  not  exposed  to  the 
pernicious  effects  pointed  out  by  Poufick  and  Landois.  The 
introduction  of  the  former  is  less  likely  to  produce  fever  than 
milk;  but  the  fever  following  the  transfusion  of  milk  is  prob- 
ably unconnected  with  the  setting  free  of  haemoglobin,  the 
consequent  renal  complication,  and  the  resultant  ursemic  phe- 
nomena. 

Iu  puerperal  medicine  there  has  been  steady  and  commend- 
able progress.  Thanks  to  Hewitt,  Barker,  Cairns,  Goodell, 
and  others  equally  eminent,  puerperal  convalescence  has  well- 
nigh  ceased  to  be  regarded  as  a  season  of  punishment,  of  seclu- 
sion from  sunlight  and  fresh  air,  and  of  starving  penitence. 
The  conventional  charred  bread,  mean  tea,  and  meaner  slops — 
the  unsavory  products  of  shadows  badly  boiled — have  been 
supplanted  by  a  more  generous,  nutritious,  and  easily  digested 
diet,  thus  contributing  to  the  pleasures  and  comforts  and  les- 
sening the  perils  of  the  lying-in. 

The  subject  of  puerperal  fever  continues  to  attract  atten- 
tion ;  and  notwithstanding  the  extensive  and  valuable  re- 
searches in  pathological  anatomy,  and  especially  in  the  study 
of  the  morbid  lesions  of  the  several  diseases,  which,  unfortu- 
nately, have  been  too  frequently  comprehended  under  the 
generic  term  "  puerperal  fever,"  certain  questions  which  con- 
stitute the  essential  basis  of  a  definite  and  practical  knowledge 
of  its  history  and  nature  remain  unsettled.  The  existence  of 
an  essential  fever,  peculiar  to  puerperal  women,  resulting  from 
unknown  blood-changes  and  unaccompanied  by  uniform  and 
constant  morbid  lesions,  is  both  affirmed  and  denied  by  men 
of  acknowledged  eminence.  But  recently  Duncan,  from  a 
careful  study  and  graphic  analysis  of  the  mortality-statistics 
of  the  city  of  London  from  1848  to  1874  (both  inclusive),  has 
reached  the  conclusion  that  "  puerperal  fever  or  pyaemia  "  is 


ESS  A  YS  A  SI)  ADD  It  hlSShlS.  \'.>,\ 

abH()lnt(;ly  Uvw  (Voiii  ('|)i(lciMi(!  |)r(;v;ilonc(;,  .'iiui  tli;i(,  it  Ii:ih  no 
(iauHiil  rchilioii  wliatsocver  citlKsr  with  (TyHijX'hiH  or  wrarlet 
fever.  Tims,  on  the  very  tl)reHhol(l  of  our  HtiidicH  we  are 
confronted  with  antagonism  of  facts  and  (led  net  ions,  and  men 
of  honest  eonviction  find  themselves  arrayed  in  open  contro- 
versy. 

The  recognition  of  th(^  morhid  (;ntities  which  are  severally 
pecnliar  to  pnerperality,  and  their  differentiation  by  distinct 
and  characteristic!  symptoms,  has  extended  and  enlarged  the 
resources  of  preventive  and  curative  medicine;  but  the  rela- 
tion of  the  lesions  to  the  parturient  womb  remains  obscured 
by  the  uncertainties  of  conjecture  and  hypothesis.  It  was 
long  ago  admitted  that  parturition,  though  a  physiological 
process,  was  necessarily  one  of  violence.  Van  Swieten  and 
Willis,  two  centuries  ago,  and  Eisenmann,  in  1887,  regarded 
puerperal  fever  as  ''  wound-fever  ; "  then  followed  the  theories 
of  Cruveilhier,  Simpson,  and  others,  who  traced  its  analogy 
\jO  surgical  fever ;  then  a  further  advance  when  phlebitis  and 
lymphangitis  were  first  recognized;  then,  again,  a  grander 
progress  when  the  pyemic  and  septicsemic  processes  were  elu- 
cidated and  the  doctrines  of  thrombosis  and  embolism  were 
promulgated  by  Virehow.  To  these  have  been  added  the 
investigations  into  the  nature  and  intensity  of  septic  poisons ; 
the  theory  of  parasitic  disease  ;  and  the  researches  of  Sander- 
son *'  on  the  infective  product  of  all  acute  suppurative  inflam- 
mations." Now  all  have  come  with  Buhl,  Yirchow,  Kolb, 
and  others  to  regard  the  traumatism  of  the  inner  uterine  sur- 
face, the  unavoidable  lesions  of  continuity  in  the  generative 
tract,  and  thrombosis  of  uterine  sinuses  as  foci  of  disease. 

The  recent  investigations  of  Leopold  and  Championniere 
into  the  histological  anatomy  of  the  lymphatics  of  the  uterus 
and  its  appendages  furnish  additional  opportunities  for  patho- 
logical research,  and  enable  us  to  trace  through  continuous 
channels  the  extension  and  propagation  of  disease  from  the 
original  foci  and  the  infection  of  parts  far  removed  from  the 
primary  seat.     So  numerous  are  the  lymphatics  of  the  uterus, 


132  ESSAYS  AND  ADDRESSES. 

and  ramifying  as  they  do  throughout  the  parenchyma,  the 
subserous  tissue,  and  mucous  lining,  they  cannot  be  omitted 
from  the  study  of  the  life  and  pathology  of  the  organ.  '^  In 
gravid  uterus,"  says  Cruikshank,  ''the  trunks  of  the  hypo- 
gastric absorbents  are  as  large  as  a  goose-quill,  and  the  ves- 
sels themselves  so  numerous  that  when  injected  with  quick- 
silver one  would  have  been  almost  tempted  to  suppose  the 
uterus  consisted  of  absorbents  only." 

In  view  of  the  importance  of  these  recent  researches  I  may 
be  pardoned  for  quoting  the  following  summary  of  the  results 
of  Leopold's  investigations: 

"  The  lymphatics  of  the  raucous  membrane  consist  of 
lymph-spaces,  representing  the  interstices  of  the  minute  con- 
nective-tissue framework,  along  the  bundles  of  which  are 
endothelia.  The  membrane  of  the  glands  is,  in  the  deeper 
layers,  a  fine  layer  of  delicate  connective-tissue  bundles,  whose 
endothelia  are  applied  externally;  nearer  the  surface  it  is  a 
sheath,  composed  only  of  "  platiform  cells."  The  bloodves- 
sels, from  the  finest  capillaries,  possess  a  number  of  fine  endo- 
thelial sheaths.  The  connective-tissue  framework  stands  in 
direct  communication  with  both  kinds  of  sheaths ;  therefore, 
both  glands  and  bloodvessels  pass  directly  through  the  lymph- 
cavities,  separated  from  the  latter  only  by  their  endothelial 
sheaths  formed  of  the  connective-tissue  trabeculse.  At  the 
boundary  of  the  muscular  layer  the  lymph-spaces  pass  for  a 
short  distance,  deeper  in  woman  than  in  animals,  into  the 
funnel-shaped  excavations  between  the  muscle-bundles,  and 
gradually  narrow  down  to  the  intermuscular  lymph-vessels 
and  tracks. 

"  The  muscularis  contains  both  lymph- vessels  and  spaces, 
the  walls  of  which  are  the  fine  intermuscular  connective  tis- 
sue. The  former  are  lined  by  fine  endothelial  lamellae,  pre- 
senting openings  and  gaps  here  and  there;  the  latter  are  lined 
by  delicate  cell-plates.  In  the  human  uterus  the  lymph- vessels 
are  very  much  entangled  by  the  peculiar  arrangement  of  the 
muscularis ;  they  are  most  commonly  abundantly  developed 


KSSA  YS  A  Nl>  A  DDRESSKN.  ]  .'i.'i 

ill  tlio  oxl(Tii;il  layer  and  in  tlu;  oIIkt  laycrrn,  CHpccially  in 
tiic  vicinity  of  (lie  larger  bioodvoHHcls,  and,  ax  in  animals, 
in  (;()iin(!<-ti()n  with  tiie  snhscrosa;  vvitii  the  mueoHa  the  f!on- 
nec-tion  is  more  by  Iyin})h-sj>ue(!H.  Tiicy  (;oll<'ct  in  the  exter- 
nal layer,  especially  at  the  sides  of  the;  uterus,  in  the  form  of 
lar^e  eolleetinij^-ttihes  whieh  ])osse.ss  valves.  Th(;  lyrnph- 
8pa(!es  are  webbed  around  the  fascieidi  of  the  larger  musele- 
bundles  and  pass  into  the  lymph-vessels,  and  in  woman  are 
in  direct  eoniniunieatiou  witii  the  sj)aceH  of  the  mucous  mem- 
brane. The  larger  collecting-tubes  and  larger  bloodvessels 
are  in  immediate  proximity;  the  other  lymph- vessels,  for 
certain  distances,  are  accompanied  by  bloodvessels,  and  the 
lymph-spaces  and  fissures  are  always  traversed  by  smaller 
vessels. 

''  Beneath  the  serosa  only  lymph-vessels  are  found  lying 
in  the  connective  tissue  and  forming  large,  entangled,  tense 
networks,  possessing  large  ampullse,  radiating  points,  con- 
strictions, valves,  contractions,  and  dilatations,  and  like  a 
network  enclose  the  entire  uterus,  forming  upon  the  anterior 
and  posterior  surfaces  a  number  of  small,  minutely  twisted 
nets,  with  thin  and  thick  canals,  and  numberless  ramifica- 
tions with  branches,  which,  during  pregnancy,  may  be  dem- 
onstrated as  far  as  and  into  the  fimbriae  of  the  tubes,  and 
other  branches  communicating,  where  the  serosa  is  firmly 
adherent  to  the  uterus,  with  the  subjacent  lymphatics  of  the 
muscularis,  while  the  superficial  vessels  of  the  loosely  at- 
tached serosa  enter  directly  into  the  larger  lymph-tubes ;  so 
that  from  the  periphery  of  the  uterus  the  lymph-current  is 
through  the  muscular  vessels  to  the  tubes  of  the  parame- 
trium, while  from  the  sparse  vessels  it  is  direct  to  the  trunks. 

''  From  the  lymph-spaces  of  the  mucous  membrane  the 
lymph  passes  through  the  mucous-membrane  funnels  into  the 
lymph-fissures  and  vessels  of  the  muscularis,  is  here  webbed 
around  all  bundles  and  fasciculi  as  far  as  the  serosa,  and  then 
unite  from  all  sides  in  the  large  collecting-trunks,  which,  in 
the  vicinity  of  large  bloodvessels,  euter  the  ligameutie  latte." 


134  ESSAYS  AND  ADDRESSES. 

Champiouuiere  has  shown  the  existence  of  networks  of 
lymphatics  above  the  lateral  vaginal  cul-de-sac  and  in  the 
lax  cellular  tissue  which  environs  the  neck,  and  has  also 
shown  the  existence  of  vessels,  remarkable  for  their  number 
and  dimensions,  climbing  up  alongside  of  the  uterus  and 
reaching  the  broad  ligament.  He  has  further  pointed  out 
the  arrangement  of  the  lymphatics  in  the  uterine  tissue  and 
broad  ligaments  in  ampullae,  upon  the  walls  of  which  numer- 
ous smaller  vessels  open,  and  which  sometimes  are  dilated 
into  purulent  cavities.  He  especially  insists  upon  the  inti- 
mate relation  of  the  uterine  lymphatics  with  the  peritoneum; 
the  annexes;  with  the  cellular  tissue  on  the  lateral  portions 
of  the  neck,  the  body,  the  iliac  fossse,  and  the  lumbar  region. 
He  has  shown  the  presence  of  glands  in  the  vicinity  of  the 
neck  and  on  the  side  and  behind  it ;  above  the  lateral  vagi- 
nal culs-de-sac ;  in  the  broad  ligaments ;  at  the  level  of  the 
superior  strait,  and  in  the  surrounding  tissues  as  far  as  the 
peripheiy  of  the  pelvis.  Those  above  the  lateral  culs-de-sac 
extend  in  a  chain  of  small  glands  to  the  lateral  walls  of  the 
pelvis.  In  those  at  the  level  of  the  superior  strait  certain 
uterine  lymphatics  empty,  and  from  them  vessels  ascend  upon 
the  psoas  muscle  and  reach  the  glands  on  the  side  of  the  ver- 
tebral column  and  in  the  lumbar  region. 

It  is,  however,  impossible  to  study  the  anatomy  of  the 
lymphatic  system  of  the  uterus  and  its  appendages  completely 
without  occupying  one's  self  with  pathology,  "  which  fur- 
nishes veritable  methods"  of  demonstration.  Since  the  time 
of  Cruveilhier  lymph-vessel  inflammation  has  been  looked 
upon  as  a  frequent  accompaniment  of  puerperal  diseases  ;  but 
not  until  Virchow  promulgated  the  doctrine  of  lymph-throm- 
bosis did  pathology  advance  beyond  the  view  that  inflamma- 
tion of  the  vessels  was  either  a  constant  or  necessary  part  of 
the  morbid  changes,  and  that  the  extension  and  propagation 
of  disease  were  by  continuity  of  surface  or  by  contiguity  of 
affected  parts,  or  by  some  occult  metastatic  process.  Even 
previously  attention  had  been  (Hecker,  Buhl)  directed  to  the 


/';s'.s'.'i  K,s' ,i.v/>  AnniU'jssh's.  ];}5 

condition,  in  which  lymph-voHHoIs,  diHtant  from  the  «it<TU.s, 
had  been  dihit((d  and  filled  vvitii  firm  or  flnid  maHsr-.s,  Hf)mf;- 
tinu'S  puriforin.  (Jruv(Mlhicr  hail  des(TilM'(l  ampiiiJa-like  dila- 
tations and  othorH  as  Himple  sacs  united  in  a  boad-likc  manner, 
filled  with  '^  y(Olowisli-wliite  ;uid  firm,  pnlpy,  or  creamy  «-oii- 
tents."  These  conditions  liad  l)e(!n  most  fre(|iieiitly  found  in 
the  broad  ligaments;  in  the  neighborhood  of  the  insertion  of 
the  tubes  ;  along  the  lateral  j)ortions  (Vir(;how)  of  the.  nterus; 
or,  ascending  along  the  internal  spermatic  vessels,  conld  be 
traced  to  the  lumbar  glands.  They  have  also  been  found  in 
the  walls  of  the  uterine  body  and  cervix,  and  especially  in  the 
ovaries  (Virchow),  which  are  sometimes  "  so  densely  traversed 
by  these  fiUed-up  and  dilated  lymph-vessels,  that  with  every 
section  a  number  of  yellow  plugs  or  cords  "  are  exposed  to 
view.  This  condition  Virchow  has  denominated  thrombosis. 
He  denies  that  the  contents  of  such  lymph-vessels  are  an  exu- 
dation, but  concedes  that  inflammation  of  the  coats  of  the 
vessels  may  follow,  and  the  thrombus  may  undergo  pnriforra 
disintegration.  Inasmuch  as  normal  lymph  is  but  partially, 
if  at  all,  capable  of  coagulation,  except  when  extra vasa ted 
or  exposed  to  air,  tlie  formation  of  thrombi  must  be  accepted 
as  the  evidence  of  some  chemical  or  pathological  change  in  its 
constitution,  produced  by  contamination  with  peccant  mate- 
rial absorbed  from  the  original  foci  of  disease;  and  hence 
when  present  must  be  considered  in  its  relation  to  such  pri- 
mary disease.  Thrombi  may  arrest  the  current  of  poisoned 
lymph,  become  a  barrier  to  the  further  extension  of  dis- 
ease, and  tiuis  localize  the  pathological  process.  They  may 
become  the  starting-points  of  a  new  infection,  for  '^  phleg- 
monous foci,"  or  collections  of  poisoned  lymph,  either  flnid 
or  in  masses,  or  impenetrable  glands  undergoing  puriform 
degeneration  may  and  frequently  do  become  centres  from 
which  spread  infection  to  other  and  distant  parts.  In  fact, 
Virchow  insists  that  lymph-thrombosis  is  only  associated 
with  the  graver  forms  of  puerperal  metritis  and  parametritis, 
and  is  in  itself  the  manifest  evidence  of  intense  infection. 


136  ESSAYS  AND  ADDRESSES. 

Now,  tvheu  we  have  come  to  regard  the  intertrabecular 
meshes  of  the  cellular  tissue  as  intercommunicating  lymph- 
spaces  and  the  pleural  and  peritoneal  cavities  as  expanded 
lymph-sacs,  with  numerous  stomata  opening  upon  their  surfaces 
and  communicating  with  the  lymph-vessels  and  spaces  under- 
lying their  endothelial  lining  ;  and  to  know  that  the  uterus  is 
abundantly  supplied  with  Ij^mph -tracks,  perivascular  spaces, 
and  vessels  ramifying  through  its  tissue  and  connecting  with 
efferent  trunks,  through  which  there  is  an  unobstructed  current, 
and  which  are  enlarged  by  the  gravid  process,  is  it  any  mar- 
vel that  noxious  material  having  its  origin  in  circumscribed 
necrosis  of  uterine  tissue,  or  introduced  from  without  through 
fissures,  rents,  lacerations,  or  any  trivial  lesion,  should  be 
transmitted  along  the  lymph-current,  conveyed  into  the 
blood-vascular  system,  and  thus  become  disseminated  through- 
out the  general  system?  That  disease  may  be  conveyed 
through  the  lymph-current  is  illustrated  by  following  the 
course  of  bacteria  through  the  body.  Heiberg  has  traced 
these  micro-organisms  from  the  original  colonies  on  the  inner 
uterine  surface  of  puerperal  women  into  the  larger  lymph- 
spaces  ;  the  lymph-cells ;  the  deeper  uterine  tissues ;  the 
lymphatic  glands ;  the  sinuses  of  the  retroperitoneal  glands, 
and  into  smaller  abscesses  of  the  lungs ;  and  others  have 
found  them  in  the  heart,  in  metastatic  deposits  in  various 
organs,  and  in  the  renal  tubules.  It  is  immaterial,  in  this 
connection,  whether  these  organisms  be  carriers  of  disease  or 
accidental  phenomena  attending  its  development ;  their  pres- 
ence in  localities  remote  from  the  original  colony  and  in  the 
course  of  the  lymph -current  must  be  accepted  as  corrobora- 
tive evidence  of  the  transmission  of  the  materies  morbi  through 
the  lymph-channels. 

The  literature  of  medicine  supplies  numerous  facts  illus- 
trating the  role  which  the  lymphatics  play  in  the  pathology  of 
puerperal  diseases.  Cruveilhier  has  presented  illustrations  of 
networks  of  distended  lymphatics  covering  the  womb.  Botrel 
has  traced   dilated    lymph- vessels   extending   from   diseased 


ESS  A  YS  A  NI>  A  l>  I)  It  HSSES.  \ .'}  7 

parts  of  the  wonih  to  tlm  broad  ligamentH  anfl  <o  tlic  f)f'ri- 
tonoum.  Cliampionniciro  liaH  connected  lymplian^itiH  with 
lacoralioii  of  tli(!  oh  internum.  Dnplay  found  tlw  in^niinal 
glands  inliltralod  with  |)us,  and  (inin(|uard  found  thern 
8Woll(Mi  ill  a  caHc  of  puerperal  lymphangitis.  In  .-inothfT 
case  the  latt/a-  foiuid  "  a  lumbar  gland  as  large  as  a  small 
apple  and  approached  by  several  volumininis  afferent  vessels 
filled  with  pus."  Bernutz  refers  to  two  cases  of  pelvi-peri- 
tonitis  supervening  upon  cervical  chancre,  and  admits  that 
the  inguinal  glands  are  involved  in  almost  every  case  of  cer- 
vical chancre;  nor  does  he  deny  ''the  possibility  of  uterine 
chancre  reacting  upon  the  lumbar  ganglia."  He  cites  a 
number  of  eases  showing  the  connection  which  exists  between 
inflauunation  and  ulceratioii  of  the  uterine  mucosa  and  peri- 
tonitis, but  docs  not  admit  the  propagation  of  the  disease  to 
the  peritoneum  through  lymph-channels  or  its  extension  from 
intrapelvic  lymphitis.  Mme.  Boivin  and  A.  Duges  not  infre- 
quently observed,  in  cases  of  puerperal  metritis,  the  lymph- 
atics through  the  entire  ''  length  of  the  broad  ligament  dis- 
tended with  white,  lactiform  pus,"  and  occasionally  the  lumbar 
glands  whitened  with  similar  fluid.  They  refer  to  the  report 
of  the  thirty-six  autopsies  (Jouni.  Complementaire,  vol.  xl.  p. 
97)  in  which  pus  was  found  in  the  absorbents.  In  twenty- 
nine  of  these  a  purulent  effusion  was  found  in  the  peritoneal 
cavity,  and  they  controvert  the  assumption  that  the  pus  was 
the  product  of  a  morbid  process  involving  the  texture  of  the 
lymph-vessels.  Parry  found,  in  cases  of  puerperal  fever 
characterized  by  diphtheritic  deposits  on  the  wounds  of  the 
genital  passages,  the  lymphatics  of  the  broad  ligaments,  and 
occasionally  those  ramifying  over  the  lower  portion  of  the 
body  of  the  uterus,  occluded  by  thrombi;  and  in  one  case  in 
which  the  "  vagina  and  endometrium  were  covered  with 
diphtheritic  membrane "  he  found  the  external  surface  of 
the  uterus  enclosed  with  a  ''  beautiful  reticulum  of  lymphatic 
vessels,  some  dilated  almost  to  the  size  of  a  crow's  quill.  In 
some  the  dilatation   was  uniform;    iu   others  the  vessel   was 


138  ESSAYS  AND  ADDRESSES. 

studded  with  a  series  of  varicose  enlargements  which  might 
be  compared  to  a  string  of  beads,  and  which  varied  in  size 
from  a  millet-seed  to  that  of  a  pea,"  and  contained  a  pus-like 
fluid.  In  every  fatal  case  of  this  peculiar  form  of  puerperal 
fever  pelvic  cellulitis  was  present.  Touele  records  (Bovin 
and  Duges,  p.  330)  a  case  of  puerperal  metritis  in  which  the 
lymphatics  of  the  abdomen  were  distended  and  of  a  milky 
color;  the  thoracic  duct  was  enlarged  and  filled  with  pus ; 
and  a  large  quantity  of  puriform  fluid  was  found  in  the  peri- 
toneal cavity.  Gallard  reports  the  case  of  a  woman  who  died 
of  puerperal  fev^er  twenty  days  after  delivery,  in  which  he 
found  under  the  uterine  mucosa  minute  abscesses  containing 
yellow,  creamy  pus.  In  the  case  of  a  woman  from  whose  knee 
Mr.  Hawkins  had  removed  a  "  sloughing  bursa"  a  few  days 
previous  to  her  confinement,  and  who  died  from  fever  which 
set  in  a  few  days  after  the  operation,  the  lymphatics  of  the 
broad  ligaments  were  gorged  with  pus.  Broca  applied  the 
actual  cautery  to  an  ulcer  of  the  cervix  uteri  in  a  woman  three 
months  advanced  in  pregnancy,  and  she  died  in  a  few  days. 
In  this  case,  besides  the  general  peritonitis,  the  lymphatics 
on  each  side  of  the  womb,  which  were  traced  to  the  ulcer, 
were  filled  with  pus.  D'Espine  reports  the  case  of  two 
women  who  died  after  an  operation  on  the  pudenda,  in 
which  the  pelvic  lymphatics  were  distended  with  pus;  and 
in  a  case  in  which  death  followed  the  removal  of  a  chancroid 
from  the  cervix  uteri.  Buhl  found  the  lymphatics  alongside 
of  the  womb  filled  with  pus.  Championniere  found  the  lymph- 
glands  alongside  of  the  womb  enlarged  and  red,  and  in  the 
cavity  of  the  body  pieces  of  putrid  placenta.  Guerin  has  re- 
cently reported  two  cases  of  periuterine  lymphadenitis  follow- 
ing delivery;  and  D'Espine  found  the  lymph-vessels  filled 
with  a  fetid  fluid  similar  to  that  found  in  the  cavity  of  the 
womb,  in  which  were  bits  of  putrid  placenta.  These  illus- 
trations demonstrate  the  anatomical  distribution  and  connec- 
tions of  the  uterine  system  of  lymph-channels  and  exemplify 
the  facility  with  which  morbid  conditions  and  ichorrhsemic 


/';,S',SM  K,S'  AND  ADDItlCSSKS.  ]'.\[) 

lliiids  niiiy  Ix;  Iriiiistiiillcfl  (Vorii  (Ik;  oi-i^/iiial  fo'i  of  (li.sfaHe 
l()(!al('(I  in  llic  ulciiiK!  tinsiieH  to  other  and  vcawAc  jtarts 
tliroiifz;!!  iJic  lyiii|)li:iti(;  ii|)|)aratiiH. 

The  patliul()ii;y  of  jjiiorpcjral  cclainpsiu  ooiitii)ueH  .so  involved 
by  tlie  confusion  of  oonfli(!ting  opinion.s  that  the  student  is 
worse  confounded  than  were  th(!  bnihlers  at  the  Tower  of 
Babel.  But  notwitlistanding  this  diversity  and  contrariety 
of  opinion,  there  are  a  few  facts  which  may  be  profitably 
studied  in  connection  with  recent  discoveries. 

First.  About  90  per  cent,  of  the  cases  of  puerperal  eclamp- 
sia are  associated  with  albuminuria. 

Second.  Much  larger  number  of  the  autopsies  of  women 
dying  of  puerperal  convulsions  exhibit  renal  lesion;  and 
Bright's  disease  in  women  is  most  frequently  among  the 
childbearing  and  during  the  childbearing  period.  Hence  the 
corollary  is  inevitable,  that  pregnancy  stands  in  the  relation 
of  cause. 

To  this,  however,  there  is  an  apparent  contradiction,  in 
that  primiparse  and  plural  pregnancies  are  more  liable  to 
convulsions  than  multipara,  whereas  by  parity  of  reasoning 
the  reverse  should  be  obtained. 

The  excess  of  liability  iu  the  primiparse  and  plural  preg- 
nancies, and  the  additional  fact  that  depletion  of  the  gravid 
womb  is  the  most  certain  method  of  terminating  the  convul- 
sive attacks,  has  given  undue  prominence  to  the  mechanical 
theory  of  causation — /.  e.,  obstructive  hypersemia  of  the  kid- 
neys. I  acknowledge  the  force  of  this  hypothesis,  but  can- 
not accept  its  absolute  verity.  That  a  kidney  engorged,  either 
with  arterial  or  venous  blood,  should  yield  a  diminished  quan- 
tity of  urine,  and  that  it  should  be  stained  with  blood  and 
contain  albumin,  either  or  both  is  not  remarkable ;  nor  is  it 
extraordinary  that  such  a  couditiou  should  result  in  the  pro- 
duction of  lesions  similar  to  if  not  identical  with  the  ordi- 
nary post-mortem  appearances  found  iu  c^ses  of  Bright's 
disease.  But  it  is  the  presence  of  the  gravid  womb,  not  of 
every  abdomiual   tumor,   which   is   so  frequently   associated 


140  ESSAYS  AND  ADDRESSES. 

with  albuminuria.  Nor  is  this  phenomenon  only  incident  to 
the  period  of  greatest  mechanical  disturbance,  but  to  the  con- 
dition of  gravidity,  and  oftentimes  is  present  long  anterior 
to  the  commencement  of  convulsions  or  to  the  completion  of 
the  term.  It  is  but  a  symptom  denoting  a  change  in  the 
blood-pressure,  either  in  the  renal  vessels  (Wagner),  or  in 
those  of  the  whole  body,  or  alterations  in  the  parenchyma  of 
the  kidneys,  or  true  disease  of  the  renal  substance,  or,  per- 
haps more  frequently,  an  altered  condition  of  the  blood.  If, 
then,  interruption  of  the  blood-current  through  the  emnlgent 
veins  be  a  factor,  it  must,  like  many  of  the  accidental  phe- 
nomena of  utero-gestation,  be  classed  as  an  adjuvant — the 
culminating  event — and  as  such  offers  an  explanation  of  the 
greater  frequency  of  convulsions  among  the  primiparse,  be- 
cause of  the  greater  tension  and  rigidity  of  the  abdominal 
walls  and  the  unaltered  relations  of  the  angle  of  pelvic  incli- 
nation. Pregnancy,  not  the  period  of  utero-gestation,  is  the 
essential  factor.  The  cause,  then,  must  lie  in  the  altered  re- 
lation, not  of  the  parts  which  lie  in  anatomical  contiguity, 
but  of  the  functions  of  the  animal  economy. 

During  pregnancy  the  mass  of  blood  (which  increases  with 
the  wants  of  the  foetus)  is  augmented ;  its  constituent  fibrin  is 
increased  ;  the  albumin  is  diminished  ;  the  number  of  red 
blood-corpuscles  is  reduced  (most  markedly  so  during  the 
later  months);  its  temperature  is  elevated  ;  there  is  a  dispo- 
sition to  venous  stasis,  general  or  affecting  particular  vas- 
cular regions  or  systems ;  the  proportions  of  solids  lessen 
and  the  quantity  of  water  increases  witli  the  progress  of  ges- 
tation ;  the  normal  relation  which  exists  between  the  fibrin 
and  water  is  disturbed ;  there  is  hypertrophy  of  the  left  ven- 
tricle; the  heart  becomes  more  vigorous;  arterial  tension, 
especially  in  the  primiparse,  is  increased,  and  during  labor 
the  blood-pressure,  both  arterial  and  venous  (Fritsch),  rises 
while  a  uterine  contraction  is  present.  Thus,  conditions 
favoring  fibrin-separation  and  congestions  are  present  to  a 


ESSAYS  AND  A  DDIIESSES.  MI 

remarkable  degnjc,  and  vaiioiis  vi.sfcra — hraiii,  heart,  lnn^s, 
and  Uidiioys — may  be  congested.  There  are  also  added  and 
retained  effete  produets  of  the  blf)od,  and  aH  a  f;on.se<jiienr« 
increased  strain  u|)on  the  kidneys.  In  the  primipane  the 
vascular  apparatus  (F.  IJai'nes)  is  not  adaptfid,  and  in  many 
prcj^nant  women  the  assimilation  oC  nntriment  is  inadecpiate 
to  the  added  physioioj^ical  work;  and  th(!  tension  of  the  wre- 
bral  vessels,  which  increases  with  the  progress  of  gestation, 
attains  its  maximum  during  parturition  when  convulsions 
most  frc(piently  occur.  There  are,  in  addition,  an  increase  of 
nerve-force,  irritation  of  the  pneumogastric,  and  a  nervous 
sensitiveness  especially  characteristic  of  pregnancy. 

The  evacuation  of  the  gravid  uterus  is  followed  by  engorge- 
ment of  the  abdominal  veins,  which  had  been  more  or  less 
obstructed  by  the  pressure  of  the  enlarged  organ.  This 
abstraction  of  blood  from  the  thoracic  organs  and  from  the 
brain,  harmless  as  it  is  in  most  cases  of  parturition  and  salu- 
tary as  it  proves  to  be  in  a  majority  of  cases  of  convulsions, 
may  result  in  such  a  condition  of  cerebral  auseraia,  enfeebled 
and  irregular  cardiac  action,  and  deearbouization  of  the  blood 
as  to  become,  in  conjunction  witb  the  deteriorated  condition 
of  the  blood-mass,  the  immediate  and  exciting  cause  of  post- 
partum convulsions. 

The  condition  of  the  blood  during  pregnancy  simulates 
anpemia,  which  is  aggravated  by  the  loss  of  albumin;  yet  the 
condition  of  the  system  is  that  of  physiological  plethora,  due 
to  the  increment  of  the  blood-mass.  During  pregnancy  and 
during  labor  the  brain  may  contain  a  redundancy  of  this  im- 
poverished and  deteriorated  blood,  and  yet  be  insufficiently 
nourished.  The  sudden  engorgement  of  the  abdominal  veins 
after  delivery  may  withdraw  from  the  brain  the  requisite 
amount  of  fluid.  In  both  instances  the  brain  is  anemic — in 
one  case  containing  an  excess,  in  the  other  a  deficiency  of  the 
altered  and  toxaetuic  blood.  Landois  claims  that  venous  hyper- 
ajmia  of  the  medulla  will  occasion  epileptiform  convulsions; 


142  ESSAYS  AIsW  ADDRESSES. 

and  Hermann  and  Escher  (Wagner)  have  shown  by  experi- 
mentation that  such  convulsions  may  result  from  either  a 
diminished  or  increased  supply  of  blood  to  the  brain. 

To  these  physiological  departures  from  a  condition  of 
health,  due  to  the  pregnant  state  aud  taking  place  coinci- 
dently  in  the  blood,  the  vascular  apparatus  aud  the  nervous 
centres,  most  rapid  in  their  progressive  development  and 
manifest  iu  their  effects  upon  the  animal  economy  during  the 
period  when  puerperal  convulsions  usually  occur,  aud  to  the 
consecutive  and  consequent  morbid  changes,  we  must  look  for 
the  predisposing  and  proximate  causes  of  puerperal  eclampsia. 
It  is,  however,  my  purpose  at  present  to  associate  these  con- 
ditions with  other  facts  which  have  but  recently  come  to  our 
knowledge. 

The  physiological  phenomena  which  favor  cerebral  conges- 
tion lend  force  to  the  once  very  commonly  accepted  theory 
that  puerperal  convulsions  were  occasioned  by  a  determina- 
tion of  blood  to  the  head.  This  view  derives  important  cor- 
roboration from  the  anatomical  resemblance  of  the  arterial 
cerebral  circulation  in  women  and  in  the  cow,  to  which  par- 
turient apoplexy  and  convulsions  are  mainly  confined.  The 
points  of  resemblance,  as  indicated  by  Prof.  Walley,  are  in 
connection  with  the  distribution  of  the  internal  carotids  and 
the  formation  of  the  basilar  artery  and  the  circle  of  Willis, 
which  favor  a  larger  and  more  direct  supply  of  blood  to  the 
brain,  especially  to  the  medulla  oblongata  and  pons  Varolii — 
the  centres  from  which  emanate  the  convulsive  action  in  puer- 
peral eclampsia.  If  these  researches  should  be  confirmed  by 
future  investigations,  we  have  present  during  pregnancy  a 
condition  of  the  blood,  increased  arterial  tension,  augmented 
blood-pressure,  and  an  anatomical  arrangement  of  the  brain 
vascular  apparatus — which  favor  intracranial  congestion.  To 
these  may  be  added  toxsemia  from  destruction  of  the  red  blood- 
corpuscles  and  retained  effete  products  from  renal  congestion; 
malnutrition  from  the  loss  and  comsumption  of  albumin  and 
from  inadequate  supply  of  nutriment;  deficient  consumption 


f;,s',s'. I  r,s' . I A7>  Ai)i)i'j':ssi':s.  \.\:>, 

of  oxy\i^v.\\  from  (liiniiinlion  of  Miiisciilnr  action;  and  the 
various  inciidcntal  iktvoiih  |)li(;nnincna  wliidi  ho  frc^jiiently 
conipliciitc  tli(;  jx-riod  of  nt(!ro-}rc.statioii.  All  tlics*;,  aciting 
togetlier  in  the  tnrhidont  union  of  untoward  fivcnts,  fMjIminate 
in  convulsions. 

Jiut  perhaps  the  most  important  contribution  ree(!ntly  made 
to  the  istudy  of  the  nature  of  puerperal  cclam[)sia  eonsists  in 
the  recognition  of  the  febrile  phenomena  so  uniformly  asso- 
ciated with  the  convulsive  seizures. 

Quincke  was  the  first  to  observe  the  elevation  of  tempera- 
ture in  puerperal  eclampsia ;  but  to  Bournoville  we  are  in- 
debted for  the  first  series  of  systematic  observations.  From 
carefully  recorded  thermometric  observations  in  seventeen 
cases,  including  four  fatal  cases,  he  deduces  the  following 
conclusions: 

1.  '^  During  the  eclampsic  state  the  temperature  is  raised 
from  the  outset  of  the  attack  to  its  termination. 

2.  '^  In  the  intervals  of  the  attacks  the  temperature  re- 
mains elevated,  and,  at  the  moment  of  the  convulsions,  a 
slight  ascension  takes  place. 

3.  ''  If  the  eclampsic  condition  is  about  to  terminate  in 
death,  the  temperature  continues  to  augment  and  reaches  a 
very  elevated  figure;  if,  on  the  contrary,  the  attacks  diminish 
and  the  coma  ceases  in  a  definite  manner,  the  temperature 
lowers  progressively  and  returns  to  the  normal  standard." 

In  June,  1875,  M.  Dieude  published  four  new  observa- 
tions, two  of  which  confirmed  the  opinions  of  Bourneville; 
the  others  invalidated  in  part  the  proposition  that  the  tem- 
perature was  elevated  in  eclampsia,  and  incidentally  the 
proposition  that  in  the  intervals  it  was  maintained  at  a  high 
degree  and  slightly  elevated  at  the  time  of  the  convulsions. 
In  December  last  Herbart  published  three  additional  cases  ; 
a  single  observation  has  been  made  by  Richardson  and  two 
by  myself,  making  in  all  twenty-seven  cases.  With  the  ex- 
ception of  the  two  cases,  before  referred  to,  the  observations 
confirmed  the  conclusions  deduced  by  Bourneville ;  of  these 


144  ESSAYS  AND  ADDRESSES. 

twenty-five  cases  seven  died.  A  single  death  occurred  with 
a  temperature  as  low  as  102.4°  F. ;  in  the  other  six  cases  the 
highest  elevations  ranged  from  104°  to  109.5°  F.  Among 
the  recoveries  the  temperature  rose  in  one  case  to  105.8°,  and 
in  another  to  106°.  Therefore,  the  maximum  of  safety  can- 
not be  established ;  but  in  all  tlie  fatal  cases  the  temperature 
remained  elevated,  and,  when  lessened,  recovery  followed. 
No  death  occurred  with  a  temperature  below  102.4°,  and  no 
recovery  took  place  with  a  temperature  above  106°.  The 
thermometric  curve  was  not  uniform,  because  of  the  altera- 
tions produced  by  the  effect  of  the  therapeutic  agents. 

These  results  present  important  indications  in  regard  to  the 
treatment  and  prognosis  in  cases  of  puerperal  eclampsia.  The 
value  of  remedies  may  be  determined  by  the  modifications  of 
the  temperature,  and  their  inutility  may  be  established  by  its 
progressive  elevation.  The  fever,  be  it  a  factor  of  causation 
or  a  coincident  phenomenon  of  the  convulsive  environment, 
is  manifestly  an  element  of  danger.  This  inference  is  cor- 
roborated by  the  varying  successes  of  the  different  therapeutic 
agents  which  have  from  time  to  time  been  employed  in  the 
treatment,  and  which  owe  their  efficacy  to  their  antipyretic 
qualities,  or  rather  to  their  power  to  abstract  body-heat. 
Venesection,  which  at  one  time  was  regarded  as  the  "  sheet- 
anchor"  of  hope  and  even  now  has  many  advocates,  not  only 
diminishes  the  mass  of  blood,  lessens  arterial  tension,  and  re- 
lieves blood-pressure,  but  produces  rapid  falling  of  the  tem- 
perature in  the  well  as  in  the  sick.  This  effect  may  be  tran- 
sitory and  speedily  followed  by  increased  arterial  tension  and 
an  elevation  of  temperature,  but  the  fever-curve  of  eclampsia 
exhibits  marked  depression  after  the  abstraction  of  blood. 
In  Richardson's  case  the  temperature  fell  from  108  F.  °  to 
102°  after  venesection,  but  the  tenseness  of  the  jugular  veins 
and  unconsciousness  continuing  a  second  abstraction  of  blood, 
with  the  application  of  an  iced  collar  to  the  neck,  established 
convalescence.  In  Herbart's  case  the  abstraction  of  twenty 
ounces  of  blood  was  followed  by  an  immediate  fall  of  1°,  and 


l'J,S,SA  YS  AND  AD  DRESSES.  146 

in  i\w  live  sii('(',('(;(liii<i;  lioiif.s  of"  .'{.T)'^.  The  illiiHtrjilions  rnif^ht 
be  niiilli|)Ii<(l  ;  and  even  in  tli(!  FmIjiI  < anes  vene.section,  when 
cni|)l()y(;(l,  (mIIut  foi*  a  time  stayed  tlu;  |)rof^r('S3lve  elevation 
or  depressed  tlie  temperature!,  to  rise  again. 

Chloroform  nareosis  lowers  body-heat  by  diminishing  the 
rapidity  (Billroth)  of  metamorpliosis,  thus  lessening  the  pro- 
duetion  of  heat.  Chloral  hydrate  lessens  heart-aetion  and 
lowers  temperature.  In  the  fever  of  eclampsia  the  effect  of 
both  of  these  ascents  is  marked  by  the  descent  of  the  curve. 
Veratrura  viride,  so  highly  extolled  by  Hearn,  depresses  the 
temperature,  slows  the  heart,  lessens  arterial  tension,  and 
diminishes  blood-pressure.  Digitalis  diminishes  the  activity 
of  hcat-rproductiou.  Acouite  depresses  the  body-heat  ''by 
its  paralyzing  action  on  the  heart  and  organs  of  circulation," 
Cold  affusions,  purgation,  and  nauseants  lessen  body-heat.  In 
brief,  the  successful  methods  of  treatment  of  puerperal  con- 
vulsions illustrate  the  "  principle  of  physiological  antagonism 
of  therapeutic  agents  to  the  febrile  state."  I  may  add  the 
evacuation  of  the  gravid  womb  in  its  physiological  influences 
diminishes  the  temperature.  Nature  indicates  her  resources 
in  expediting  the  depletion  of  the  uterus  in  very  many  cases 
of  puerperal  eclampsia  ;  and  it  is  a  fact  that  in  a  majority  of 
cases  the  convulsions  cease  or  diminish  in  frequency  and 
intensity,  with  a  marked  reduction  of  temperature  immedi- 
ately upon  the  completion  of  delivery. 

I  will  advance  a  step  further  and  submit  the  proposition 
that  the  various  methods  of  preventive  treatment  niaiuly 
owe  their  efficacy  to  their  effect  upon  the  blood  and  blood- 
vascular  apparatus.  As  a  rule,  these  are  directed  to  the  pro- 
motion of  nutrition,  whereby  the  loss  of  albumin  is  replen- 
ished, and  to  the  relief  of  the  hydrsemic  condition  of  the 
blood  by  catharsis,  diuresis,  or  diaphoresis.  Heretofore  the 
explanation  of  these  excretory  operations  has  rested  for  the 
most  part  upon  the  theory  of  eliminating  the  excremeutitial 
and  toxic  elements  accumulated  in  the  blood.  Xot  less  im- 
portant is  the  simultaneous  effect  in  restoring  the  relation  of 

10 


146  ESSAYS  AND  ADDRESSES. 

the  solid  and  fluid  parts,  relieving  arterial  tension  and  dimin- 
ishing blood-pressure.  The  phenomena  and  consequences 
(Wagner)  of  diminution  of  albumin  are  disturbances  of  the 
endosmotic  and  exosmotic  properties  of  the  blood,  "  insuffi- 
cient formation  of  digestive  fluids,"  altered  nutrition,  and 
repair  of  tissues,  inanition,  and  albuminuria. 

Time  will  not  permit  me  even  to  enumerate  the  almost 
numberless  new  suggestions  "with  which  the  literature  of 
gynecic  medicine  has  been  embellished  during  the  past  year. 

In  a  branch  of  medicine  so  rich  in  its  opportunities  for 
physiological  and  practical  research  it  would  indeed  be  strange 
if  a  single  year  should  pass  without  substantial  contributions 
being  made  to  our  knowledge,  yet  it  cannot  be  said  that  in 
this  extended  field  of  inquiry  a  single  disputed  question  has 
been  finally  and  conclusively  settled  during  the  period  we  are 
reviewing.  Accepted  theories  have  been  disputed;  old  doc- 
trines have  been  controverted ;  established  methods  of  treat- 
ment have  been  revised  and  new  ones  instituted;  and  addi- 
tional aids  to  diagnosis  have  been  discovered.  Research  seems 
rioting  in  chaotic  controversy,  and  the  maxims  of  the  masters 
are,  one  by  one,  disappearing  before  the  innovations  of  the 
student.  We  seem  as  if  standing  in  the  dawn  of  a  coming 
epoch  when  the  results  of  these  inquiries  will  be  realized  and 
conclusions  will  be  reached  freed  from  theory  and  individual 
bias  and  based  upon  undisputed  physiological  and  pathologi- 
cal data.  Then,  and  not  till  then,  broad  and  comprehensive 
principles  will  take  the  place  of  individual  observation  and 
personal  experience,  and  the  practitioner  will  merge  the  ex- 
perimentalist in  the  student. 

The  deficiency  of  gynecic  medicine  in  accepted  data  suffi- 
cient to  establish  definite  opinions  has  been  illustrated  in  the 
recent  discussions  concerning  the  nature  of  menstruation  and 
its  relation  to  ovulation.  Men  of  undoubted  ability  and  im- 
partial judgment  differ  in  regard  to  the  condition  of  the 
uterine  mucosa  before,  during,  and  subsequent  to  the  peri- 
odic discharge  of  blood  and  in  the  significance  of  the  observed 


ES,SA  )  'S  AND  AD  DRESSES.  ]  4  7 

plienoiiiciia.  One,  at  Icasi,  lias  vcnliirfid  to  deny  tin;  pliy.sio- 
logical  nature  of  menHtriiation  and  essayed  to  do  away  with  the 
entire  basis  of  ])hyHioloi^ieal  invcHtijration  by  insistinj^  that  it  is 
a  ])ath()lo<^i('al  process  whi(;h  must  find  its  prevention  in  im- 
pregnation during  one  of  the  pre-menstriial  ovulatory  perirxls 
and  the  quick  and  successive  repetition  of"  inij)regnation  until 
the  cliniactoric  period  shall  have  passed.  While  such  con- 
clusions are  maintained  it  is  not  strange  that  the  therapeutical 
management  of  menstrual  diseases  should  vary  according  as 
the  practitioner  a(!cepts  tlie  results  of  one  or  of  another  in- 
vestigator, and  many  must  stray  far  away  from  a  rational  and 
philosophical  basis  of  medication.  Each  will  eagerly  grasp 
the  opportunities  lor  treatment  presented  by  the  views  he 
accepts.  But  recently  Atthill,  who  regards  the  menstrual 
flow  ^' as  a  discharge  mainly  composed  of  effete  materials," 
has  essayed  to  adapt  the  tlierapeutical  management  of  amen- 
orrhoea  and  meuorrhagia  to  the  view  that  durins'  menstrua- 
tion  the  entire  mucosa  is  cast  off,  by  suggesting  that  in  certain 
forms  of  amenorrhoea  the  application  of  ''  agents  calculated 
to  hasten  and  bring  about  disintegration  "  and  desquamation 
of  the  uterine  mucosa  should  be  made  immediately  preceding 
the  expected  occurrence  of  the  flow,  and  in  c^ses  of  menor- 
rhagia  a  few  days  subsequent  to  the  termination  of  the  cata- 
menial  period. 

So,  likewise,  have  the  sudden  revolutions  in  methods  of 
treatment  been  exemplified  in  the  management  of  uterine 
fibroids.  But  a  year  ago  the  utility  of  ergot  seemed  almost 
established,  and  now  all  medication  is  threatened  supersedure 
by  surgical  processes ;  and  this  is  not  surprising  in  view  of 
the  success  of  Green halgb  with  the  actual  cautery  in  the  enu- 
cleation of  uterine  fibroids;  of  Emmet  in  removal  by  traction  ; 
of  Kidd  by  dilatation  of  the  uterus  with  numerous  pieces  of 
sea-tangle  and  subsequent  removal  by  means  of  the  ecraseur ; 
and  of  the  operation  of  gastro-bysterectomy.  These  "ad- 
vances "  in  treatment  are  the  logical  results  of  the  greater 
accuracy  attained  in  diagnosis,  by  which  uterine  fibroids  have 


148  ESSAYS  AND  ADDRESSES. 

been  classed  according  to  their  amenability  to  medical  or  sur- 
gical treatment;  and  though  a  greater  number  of  cases  have 
been  relegated  to  surgery,  a  larger  proportion  of  cases  have 
been  rescued  from  the  class  hitherto  regarded  as  incurable. 
Then,  too,  medicine  is  threatening  to  snatch  from  the  domain 
of  surgery  its  highest  operation  in  gynecic  medicine  by  the 
substitution  of  electrolysis  for  ovariotomy.  So  successful  has 
this  method  proved  in  the  practice  of  Dr.  Semeleder  that  I 
hesitate  to  accept  his  statement,  and  am  startled  at  the  thought 
that  the  greatest  triumph  of  modern  surgery  is  to  be  super- 
seded by  a  process  so  simple  and  so  painless. 


MEDICAL  DEPARTMENT  OF  THE  UNIVERSITY 
OF  GEORGETOWN. 

ADDEESS    DELIVERED    AT    THE    TWENTY-EIGHTH    ANNUAL 

COMMENCEMENT    OF    THE    MEDICAL    DEPARTMENT 

OP   THE    UNIVERSITY    OF    GEORGETOWN, 

MARCH    19,    1877. 

Mr.  President  and  Ladies  and  Gentlemen.  Gen- 
tlemen OF  THE  Graduating  Class  :  I  congratulate  you 
upon  your  elevation  to  the  doctorate  of  medicine,  and  wel- 
come you  to  the  brotherhood  of  the  medical  profession. 

With  the  termination  of  these  exercises  our  relations  as 
teacher  and  pupil  end.  No  grief  should  embitter  this  sepa- 
ration; no  sorrow  mar  these  nuptial  ceremonies.  Here,  in 
the  presence  of  this  splendid  galaxy  of  beauty  and  loveliness, 
of  friends  and  companions,  assembled  as  guests  and  witnesses, 
where  every  face  is  radiant  with  joy  and  every  tongue  awaits 
the  opportunity  to  bid  you  success  and  happiness,  you  have 
assumed  newer  and  higher  duties,  other  and  graver  responsi- 
bilities, and  now  your  alma  mater  bids  me  deliver  to  you  her 
final  admonition. 


ESS  A  YS  A  NI)  A  D  DRESSES.  ]  ■\  0 

It  has  bec'oino  your  |)rou(l  olTico  to  tend  the  flonlily  V.i\><:r- 
nade  of  the  immorlal  spirit ;  to  rnitigato  the;  |ianfrs  and  corn- 
bat  the  ravages  of  disease ;  to  alleviate  the  suffering  and  solaee 
the  sorrows  of  the  .'ifTlietod  ;  to  restore  tf)  health  those  stricken 
with  disease;  to  prolong  the  lives  of  confirmed  invalids  and 
to  free  the  agony  of  dcatii  froirj  bodily  pain,  and  your  path, 
if  rightly  followed,  will  be  ijlninined  by  nnfctlcred  truth  and 
love  unfeigned.  You  must  be  imbued  with  the  greatness  and 
responsibility  of  your  mission,  and  your  obligations  are  the 
more  deep  and  endurii  g,  because  your  own  conscience  must 
be  the  tribunal  to  adju  Ige  the  penalties  of  ignorance  and  neg- 
lect. You  cannot  apj.ease  the  conscience  with  the  vain  dog- 
mas that  the  responsibility  of  misguided  judgment  and  mis- 
applied resource  ceases  with  the  individual  conviction  of  right 
or  that  a  life  sacrificed  in  the  line  of  duty  is  no  wrong.  This 
question  of  right  or  wrong  cannot  be  submitted  to  the  arbit- 
rament of  your  own  conscience  nor  dismissed  with  the  com- 
placent declaration  of  your  own  opinion  of  right.  The  tri- 
bunal of  justice  is  at  the  bar  of  eternity. 

Health  is  the  priceless  jewel  in  the  casket  of  life,  and  life 
is  the  birthright  of  existence.  To  your  care  and  skill  these 
will  be  committed,  and,  in  medicine,  ^'  confessedly  the  most 
difficult  and  intricate  of  the  sciences,"  knowledge  is  not  intu- 
itive. It  comes  only  to  the  earnest  and  conscientious  seeker, 
the  diligent  and  unremitting  student,  the  careful  and  pains- 
taking investigator.  The  charlatan  may  acquire  by  observa- 
tion and  experience  familiarity  with  the  effects  of  his  nostrum 
or  alleged  specific  as  the  grave-digger  may  acquire  expertness 
and  dexterity  with  his  tools.  In  no  trade  will  mankind  rely 
upon  the  skill  of  an  untaught  workman.  In  the  ordinary 
avocations  of  life,  in  the  transactions  of  business,  in  the  acqui- 
sition of  wealth,  and  in  the  attainment  of  position,  the  pur- 
pose, end,  or  aim  sought  demands  fixedness  of  purpose,  sta- 
bility and  directness  of  effort,  concentration  of  mind,  and  the 
application  of  every  available  resource.  To  these  qualities, 
in  the  diseharo;e  of  the  duties  to  which  vou  have  to-night 


150  ESSAYS  AND  ADBBESSES. 

beeu  betrothed,  you  should  add  the  highest  ideal  of  personal 
honor  and  the  most  sensitive  perception  of  right  and  wrong, 
with  the  quickening  influences  of  a  conscience  keenly  alive  to 
the  obligations  of  Christian  philanthropy. 

You  have  been  commissioned  to  ''go  heal  the  sick."  Ad- 
minister the  functions  of  your  office  with  devotion,  steadiness, 
and  humanity.  "  Unite  tenderness  with  firmness,  condescen- 
sion with  authority,  that  you  may  inspire  your  patients  with 
gratitude,  respect,  and  confidence."  Bear  in  silence  your  cares, 
with  dignity  your  responsibility,  with  humility  your  disap- 
pointments, and  with  becoming  indifference  that  ingratitude 
which  you  will  frequently  find  is  the  only  requital  for  ardu- 
ous and  self-sacrificing  services. 

As  ministers  of  hope  and  comfort  you  must  not  draw  too 
sharp  a  line  between  health  and  disease.  So  long  as  disease 
afflicts  the  human  family,  so  long  will  there  exist  antagonism 
between  health  and  disease,  and  from  the  very  nature  of  the 
circumstances  and  varying  conditions  of  the  faculty  of  reason 
as  exhibited  in  different  individuals,  there  must  exist  antag- 
onism between  science  and  ignorance.  Disease  begets  caprice, 
fosters  discontent,  exaggerates  eccentricities,  clouds  the  mind, 
perverts  the  reason,  and  masks  the  j  udgment.  The  charlatan, 
often  with  consummate  tact  and  adroitness,  appeals  to  the  in- 
valid with  faculties  thus  affected,  and  the  marvel  is  not  that 
so  many  yield  to  the  captivating  promises  of  speedy  relief,  but 
that  so  many  escape  the  injurious  and  attractive  appliances 
which  injure  their  health  and  not  infrequently  destroy  their 
lives.  As  conscientious  arbiters  you  must  determine  the  sig- 
nificance of  the  symptoms,  be  they  real  or  imaginary,  and 
apply  the  remedy,  be  it  the  comforting  assurance  of  harmless- 
ness  or  the  application  of  appropriate  agents.  Few  are  will- 
ing to  accept  the  confident  assurance  of  returning  health  with- 
out the  employment  of  remedies,  and  fewer  still  will  bear  with 
patience  the  painful  processes  of  disease  while  the  physician 
adjures  remedies  and  fosters  confidence  with  verbal  assurances. 
The  incompetent  will  strike  at  random  with  a  multitude  of 


ESSAYS  AND  ADDRESSES.  151 

agenJH  mikI  amcxvA]  i\mr  it^iioraiico  iiriflcr  tlu;  ncfiidfrntal  adap- 
tation of  (Ikmi"  r(»nmil;r.  Some  will  he  iiiipi'isscl  with  an 
assinncd  dcivotion;  otlusrs  with  a  <:;i'()t('S(jn(;n(!.sH  of  rnannf;r ; 
anotlier  will  be  won  by  winninfr  sniilcis  and  a  f^rafoful  addrfHH; 
but,  after  all,  tho  surest  road  to  siuicess  will  b(3  thron;rh  the 
diligent  a('(|iiisition  of  knowledge  and  the  faithful  discharge 
of  responsible  duties. 

Hold  inviolate  the  secrets  of  the  siek-chamber.  As  the 
trusted  friend  and  confidant,  the  foibles,  frailties,  and  faults 
of  human  nature,  the  privacies  of  domestic  life,  the  infirmi- 
ties of  temper,  and  the  defects  of  character  will  be  intrusted 
to  your  keeping. 

Now  that  I  have  delivered  to  you  the  last  injunction  with 
which  your  alma  mater  charged  me,  come  with  me  into  the 
open  field  of  labor,  that  I  may  exhibit  to  you  the  rugged  path 
of  duty  and  picture  some  of  the  scenes  of  coming  trials  and 
responsibilities. 

Go  with  me  to  the  chamber  of  the  dying  father.  He  has 
wealth  and  position  and  is  surrounded  by  all  the  comforts  of 
life  ;  his  home  is  amidst  admiring  friends  who  delight  to  honor 
him  and  to  listen  to  his  council.  His  humanity  and  benevo- 
lence have  gladdened  many  sorrowing  hearts.  No  one  in  need 
ever  appealed  in  vain  to  his  charity,  and  now,  in  the  zenith 
of  his  career,  in  the  pride  of  his  manhood,  he  is  stricken  down 
with  disease,  and  his  wasting  frame  and  declining  strength 
mark  its  fearful  progress  and  portend  a  speedy  dissolution. 
Remedy  after  remedy  has  failed.  The  faithful  physician 
stands  firmly  at  his  post  of  duty  ;  there  is  no  lack  of  resource, 
no  stinting  of  means,  no  indirectness  of  purpose,  no  frivolous 
pretext  to  escape  responsibility,  no  unwillingness  to  confess  a 
failure.  He  is  prompt  in  conclusion,  ready  in  expedient,  de- 
cisive in  application,  but  it  all  avails  uothiug.  That  doubt, 
which  so  often  stimulates  to  renewed  effort  and  lingers  long 
as  a  wise  and  faithful  counsellor,  has  yielded  to  the  inexora- 
ble reality.  The  children,  who  as  duty  called  them  had 
gone  forth  into  the  world,  have  been  summoned  back  to  the 


152  ESSAYS  AND  ADDRESSES. 

homestead.  The  legal  adviser  has  transacted  his  last  official 
duty  and  departed;  the  beloved  pastor  has  administered  the  final 
consolations  of  religion,  and  yet  the  dying  man,  still  clinging 
to  life,  appeals  with  hope  for  relief  and  safety  to  his  medical 
attendant.  The  wife,  who  has  so  tenderly  nursed  him  and 
with  so  much  sympathy  and  anxiety  watched  over  him  by 
day  and  night,  true  to  her  ^vomanly  nature  and  affection,  has, 
until  now,  failed  to  realize  his  hopeless  condition,  and,  now, 
stricken  with  grief,  crushed  beneath  the  contemplation  of  the 
hour,  leans  upon  his  arm  for  help,  assistance,  courage,  and 
hope.  The  daughter,  whose  young  bosom  has  known  no 
sorrow,  whose  joyous  life  has  been  one  uninterrupted  scene 
of  pleasure,  to  whom  the  pallor  of  death  and  the  grief  of  the 
death-chamber  have  been  strangers,  now  subdued  with  terror 
and  affliction,  comes,  with  her  bosom  heaving  with  sorrow  and 
her  heart  aching  with  anguish,  and  implores  him,  as  only  a 
daughter  can,  to  arrest  the  direful  malady  and  restore  to 
health  the  sinking  man;  and  the  stalwart  son,  who  has  stood 
unmoved  amidst  the  carnage  and  havoc  of  contending  armies, 
now,  in  broken  accents,  inquires  if  the  father  must  die  ?  Sym- 
pathizing friends  stand  near,  the  man  of  God  still  awaits  the 
departure  of  the  spirit,  all,  all  are  bowed  in  grief  ;  but  in  all 
that  company  there  is  one  unmoved  by  the  scene  around,  one 
whose  emotions  must  not  be  seen,  whose  trembling  voice  must 
not  lose  its  tone,  whose  courage  must  not  falter,  whose  self- 
possession  must  not  yield  under  the  responsibilities  of  the 
hour.  To  him  alone  the  sick  man  appeals  for  aid ;  on  his 
skill  alone  the  sorrowing  friends  and  relatives  base  all  hope. 
Experience  has  taught  him  that  life,  though  trembling  on  the 
brink  of  the  grave,  may  be  rescued,  and  he  spares  no  effort, 
exhausts  every  resource,  in  the  faithful  discharge  of  his  duty, 
until  the  last  faint  glimmer  of  life  has  gone  and  the  father 
lies  motionless  and  silent  in  death. 

ISTow  vary  the  scene.  It  is  the  young  girl  just  budding 
into  womanhood  that  is  stretched  upon  the  bed  of  sickness. 
She   has   been   reared   in    luxury.      Every  whim   has   been 


ESSA  YS  AND  A  DDItHSSES.  \  53 

indulged,  (^vc^iy  cji price  fostered.  She  is  devoted  to  fanhion,  to 
the  vanities  and  iTivolitios  of  life,  has  hfcii  jx'ttfd,  fourtfd, 
H|)oil(Hl — is  wayward,  sclf-willfd,  and  |)(;rvcrsf.  Tiie  veiier- 
uble  brother,  who  has  wat<'hf'(l  over  her  from  infancy  and  so 
often  ministered  to  her  n^licf,  is  nciithor  oh(;ycd  nor  respected, 
and  now,  after  all  the  precinrsory  symptoms — the  first  rnut- 
terings  of  the  coming  storm  have  been  unheeded  and  neg- 
lected— the  disease  has  gained  the  mastery.  The  anxious 
mother  and  indulgent  father,  no  longer  willing  to  bear  the 
responsibility,  hastily  call  the  family  physician.  The  way- 
ward girl — though  prostrated  by  disease  and  its  accompanying 
and  agonizing  pains — is  peevish,  irritable,  impatient  of  re- 
straint, cannot  bear  her  sufferings  with  becoming  composure, 
and  will  not  submit  to  the  measures  deemed  conducive  to  her 
comfort  and  demanded  by  every  consideration  of  duty. 
Neither  the  gentle  wooings  of  an  affectionate  mother,  the 
stern  will  of  an  indulgent  father,  now  aroused  to  the  exi- 
gencies of  the  occasion,  nor  the  patient  forbearance  of  the 
venerable  brother  can  infuse  into  her  stubborn  nature  a 
proper  appreciation  of  the  obligations  resting  upon  her  nor 
impress  her  feverish  intellect  with  the  impending  peril. 
Through  many  weary  days  and  nights  he  watched  by  her 
side ;  but  not  until  the  failing  powers  of  life  and  the  wasted 
physique  have  reduced  her  to  helplessness,  when  resistance 
yields  to  necessity  and  the  terrors  of  eternity  appal  her,  will 
she  listen  to  his  counsel  and  submit  to  his  discipline.  Thus, 
conquered  by  her  fears,  she  is  brought  to  the  full  realization 
of  her  dependent  and  perilous  condition,  and  then,  and  then 
only,  is  she  moved  to  acknowledge  her  error  and  to  express 
her  gratitude.  But  with  restored  health  and  returning  vigor 
the  same  inflexible  will,  the  same  profligate  demands  upon 
her  constitution,  the  same  disregard  of  the  laws  of  nature  and 
of  health,  the  same  love  of  self-indulgence  and  gratification 
of  the  tastes  and  caprices  of  her  frail  nature  recur  with  all  their 
original  embarrassments.  Neither  a  sense  of  duty  to  hereelf 
nor  the  entreaties  of  the  loved  ones  at  home,  the  warniuirs  of 


1 54  ESSA  YS  AND  ADDBESSES. 

the  doctor,  nor  the  progressive  inroads  of  disease  can  divert 
her  from  the  pursuit  of  her  pleasures  and  their  attending 
evils. 

Again  the  picture  is  changed.  That  generous  and  gifted 
youDg  man,  whose  noble  impulses,  manly  bearing,  exemplary 
habits,  and  powers  of  mind  have  made  him  conspicuous  among 
his  comrades  and  gave  promise  of  so  brilliant  a  future,  to-day 
has  partaken  of  the  tempting  cup  at  the  invitation  of  a 
friend ;  to-morrow  he  repeats  it  to  warm  his  chilled  body  ;  at 
another  time  to  correct  the  opposite  condition  ;  again,  to 
obviate  the  dangers  from  some  indiscretion  in  diet  and  then 
to  stimulate  his  desponding  spirits.  It  soon  comes  to  satisfy 
every  need,  however  contrary  and  opposite.  It  is  the  pan- 
acea for  all  bodily  infirmities  and  all  mental  disturbances.  It 
arrests  disease,  invigorates  the  body,  solaces  disappointment, 
drives  away  dull  care,  stimulates  the  imagination,  revives  the 
flagging  sensibilities,  and,  like  sleep,  "  is  wearied  nature's 
sweet  restorer. "  These  are  its  beauties  and  its  charms.  What 
are  its  vices,  its  evil  consequences  ?  Shall  I  point  you  to  the 
criminal  records,  the  prisoner's  cell  ?  No,  there  is  no  need 
of  that ;  neither  is  there  that  I  should  tell  you  those  noble 
impulses  are  all  transformed  into  brutal  passions ;  that  that 
manly  mien  is  sadly  changed,  and  that  those  high  aspirations 
have  been  changed  into  bitter  despair — all  these  and  many 
more  evidences  of  its  sad  effects  and  devastating  influences 
you  can  witness  any  day  in  the  hovels  of  the  poor,  in  the 
haunts  of  the  wicked,  and  in  the  gilded  saloons  of  our  gay 
and  fashionable  city.  For  its  accompanying  ailments  he 
seeks  our  counsel,  but  refuses  our  advice.  He  appeals  for  a 
substitute  to  slake  his  debased  thirst  and  to  appease  his  crav- 
ings, and  scorns  the  science  which  affords  no  protection  from 
the  pains  of  his  self-indulgence — no  immunity  from  the  inev- 
itable consequences  of  his  evil  tastes  and  passions.  The  trem- 
bling hand,  the  faltering  voice,  the  bloated  form,  the  declining 
health,  the  unsteady  gait,  the  sleepless  nights,  the  enfeebled 
intellect  are  with   him  the  evidences  of  his  needs,  not  the 


/':,SSA  VS  AND  ADDRESfSKS.  155 

consequejKH'H  of  his  vice,  aii<I  Ik;  scc^ks  rctlicC  in  rcii'\v*<l  |>ofa- 
tions.  At  last  the  Hhock,  so  long  delayed,  of  wliidi  lu;  lia.s 
boon  HO  ofh^i  iulmonislicd,  (H)ni('H,  nnd  tlie  tdriljlc  spcdarlo  is 
presented  ol"  a  luitnan  l)('iii<i;  divcHted  of  reason,  witli  j)ervcrte'<J 
senses  and  a  form  writhing  in  ('onvnlsfd  and  disordered  power. 
In  this  condition  lie  is  committed  to  (Mir  enre.  He  sees  in  tlie 
glorious  sunlight  of  noonday  the  consuming  flame  of  eternal 
perdition;  in  the  moving  shadows  of  his  dimly  lighted  room 
the  grim  and  ghastly  spirits  of  comrades  gone  before,  who 
have  come  back  to  steal  away  his  craven  soul;  in  the  person 
of  our  patient  brother,  the  evil  demon  who  haunts  his  dreams 
and  consumes  his  flesh;  and  he  hears  in  the  gentle  voices  of 
forgiving  friends  the  trumpets  of  fiends  without  marshalling 
to  his  rescue.  Behold  the  monster  man — see  his  glistening 
eye  reflecting  the  fury  of  his  frenzied  brain;  listen  to  his 
unhallowed  imprecations,  to  his  trembling  utterances  of  the 
coarse  and  vulgar  language  of  the  brothel;  see  his  cowardly 
spirit,  now  gloating  over  the  fancied  triumphs  of  his  valor, 
now  cowering  under  the  firm  will  of  his  attendant.  It  were 
better,  perhaps,  that  the  emasculated  form  should  go  to  the 
grave ;  but  an  immortal  soul  is  at  stake,  and  the  life  is  com- 
mitted to  our  brother's  care.  He  dare  not  turn  away  from 
the  horrid  scene,  he  cannot  abandon  his  trust,  he  cannot  seek 
repose  in  the  quiet  of  his  own  home  and  leave  the  life  to 
chance.  The  mortal  man  and  immortal  spirit  are  for  the 
time  in  his  keeping,  and  he  cannot  divest  himself  of  the  hope 
that  restored  health  may  bring  with  it  reformed  habits. 
Through  proper  aid  and  diligent  care  the  sick  man  slumbers 
in  restored  consciousness.  Now,  listen  to  his  plaintive  and 
persistent  abjurations — to  his  penitent  confessions  of  the 
woful  depravity — to  his  solemn  but  insincere  renunciation 
of  the  vice.  But  I  caunot  follow  him  through  all  the  trials 
his  life  imposes  upon  our  profession.  His  comrades  deny 
complicity  in  his  degradation,  his  friends  excuse  his  weak- 
ness, and  he  appeals  to  us  for  relief  from  the  many  ills  which 
afflict  his  declining  life. 


156  ESSAYS  AND  ADDRESSES. 

It  is  night:  the  earth  is  covered  with  darkness  ;  the  starry- 
heavens  are  obscured  by  the  storming  elements  ;  the  busy 
marts  are  deserted  ;  the  wearied  laborer  has  gone  to  his  home; 
all  animated  nature  is  seeking  repose  and  rest  in  peaceful 
sleep.  How  is  it  with  us  ?  Some  lingering  doubt  disturbs 
our  quiet ;  some  anxious  fear  renews  recollections  of  the  sad 
past ;  the  body  is  weary  with  the  labors  of  the  day  and  the 
mind  ill  at  ease.  That  young  couple  in  yonder  home  are 
aroused  from  their  happy  sleep  by  the  sudden  and  alarming 
illness  of  their  first-born,  and  the  messenger  goes  hurriedly 
for  the  physician-father.  No  bodily  infirmity  can  excuse 
him,  no  faltering  will  can  waive  the  responsibility.  He  must 
brave  the  storm,  forget  himself  ;  duty  commands  him.  Love 
for  his  profession  impels  him  onward  to  the  scene  of  suffering. 
The  little  sufferer  speaks  to  him  only  in  the  language  of  dis- 
ease. There  is  no  time  for  deliberation,  no  opportunity  for 
careful  study;  the  young  life,  in  the  agony  of  its  first  experi- 
ence, appeals,  not  for  commiseration  and  sympathy,  but  for 
that  relief  which,  as  the  instrument  of  mercy,  he  alone  can 
give.  Whether  that  sinless  soul  shall  go  to  the  realms  of 
bliss  or  stay  to  suffer  more  has  not  been  left  to  him  lo  deter- 
mine ;  but  the  resulting  issue,  life  or  death,  is  intrusted  to 
his  care  and  skill.  It  lives  and  reposes  in  peace  and  quiet 
in  its  mother's  arms,  and  on  the  morrow  its  playful  inno- 
cence and  merry  gratitude  will  fill  the  measure  of  his  recom- 
pense. If  it  should  die,  that  doubt  which  has  so  often  been 
the  monitor  of  his  skill  and  yielded  to  success  may  linger  on 
the  painful  apprehension  of  error  and  foster  the  keen  sensi- 
bilities of  his  grief.  The  melancholy  emblem  draping  the 
door-knob  is  the  pang  of  his  sorrow — the  memorial  of  his 
responsibility. 

To-day  our  city,  remarkable  for  the  healthf ulness  and  salu- 
brity of  its  climate,  is  free  from  any  prevalent  epidemic,  and 
its  peaceful  citizens  are  directing  their  energies  to  the  devel- 
opment of  its  resources,  adding  to  its  comforts,  its  con- 
veniences, and  its  luxuries.     Amid  the  bustle,  confusion,  and 


I'JSSA  VS  A  NI)  A  DhllESSES.  1  57 

tiiniioll  of  hiiHiiu'Hs,  wlicii  all  Hecni  Hlrlvli)^'-,  i",\('\\  in  IiIh  own 
sphoro,  for  tin'  ^ood  of  ilu;  wliolo,  tlie  |)hysi('i;ui  i.s  <jiiietly, 
witlioni  oHlcntulioii,  |)iirHiiin^  lil.s  nii.sHion  of  hciifvolfrK-f;  and 
phiIanlliro]>y,  tinol)H(!i'V('(l  and  unlidcdcd  save  by  tli(*  aflliftod 
few.  How  many,  revelling  in  lunltli,  engrossed  in  the  acqui- 
sition of  wealth  or  drinking  dec])  of  the  j)lf'asnres  and  ^.^aieties 
of  society,  have  forgotten  that  health  and  life  may  he  sacri- 
ficed by  some  trivial  indiscretion.  How  many  scorn  rather 
than  accept  the  admonitions  of  antecedent  ailments — deride 
rather  than  applaud  the  unselfish  suggestions  of  the  profes- 
sion— denounce  rather  than  obey  the  established  laws  of 
health — reject  rather  than  follow  advice  which  imposes  re- 
straint upon  the  gratification  of  tastes  and  which  prescribes 
a  limit  to  the  indulgences  and  excesses  of  life.  Health,  un- 
conscious [)f  its  frail  and  uncertain  tenure,  laughs  at  medicine, 
acquiring  assurance  in  its  temporary  immunity,  sneers  at 
science,  and  in  its  joy  and  pleasure  grows  fearless  of  disease. 
Who  knows  how  soon  the  scourge  may  come  ?  To-morrow's 
mail  may  bring  the  news  of  some  terrible  pestilence  decimating 
a  neighboring  city.  As  it  advances  step  by  step,  spreading 
from  city  to  village,  from  village  to  hamlet,  from  hamlet  to 
town,  it  drives  before  it  multitudes  of  people,  stricken  \^■^th 
terror  and  appalled  at  its  fatality  ;  and  in  that  moving  and 
frightened  throng  you  will  see  clergymen  and  lawyers,  authors 
and  artists,  merchants  and  tradesmen,  all  professions  and  em- 
ployments save  one — the  physician  ;  he  is  not  there — bis  duty 
is  in  the  midst  of  the  pestilence,  not  in  the  throng  fleeing  be- 
fore it.  When  it  reaches  our  city,  comes  directly  to  our  liomes, 
how  soon  the  scene  will  change.  In  the  midst  of  the  suffer- 
ing, pestilence,  and  death  our  profession  becomes  pre-emi- 
nently the  friend  of  mankind.  The  valiant  in  health  will 
then  be  suppliants  for  protection — the  brave  in  security  will 
cower  before  the  dreaded  disease,  and  the  physician  then 
achieves  the  true  dignity  of  his  mission — the  glorious  sub- 
limity of  his  office. 

Stop  a  moment  here  by  the  wayside,  at  the  home  of  the 


158  ESSAYS  AND  ADDRESSES. 

widowed  mother  and  of  these  orphan  children.  A  profligate 
father  and  a  brutal  husband  has  squandered  her  patrimony, 
and  the  law,  in  satisfaction  of  its  just  demands,  has  reduced 
her  to  penury  and  want.  To  feed  and  clothe  these  little  chil- 
dren— to  live  an  honest  and  virtuous  life — she  has  yielded  to 
inexorable  necessity,  taxed  her  feeble  strength  beyond  its 
power,  and  now,  exhausted  and  worn,  is  laid  upon  the  bed 
of  sickness.  No  pecuniary  consideration  moves  the  medical 
man  to  minister  to  her  wants.  Charity,  benevolence,  duty, 
are  the  impulses  which  prompt  him.  Noble  profession  ! 
How  pure  and  unselfish  its  aims;  "  the  servant  of  the  min- 
istry; the  handmaid  of  religion.  He  who  would  become  a 
true  physician,  in  the  elevated  and  comprehensive  significa- 
tion of  the  term,  must  surely  attain  to  the  great  dignity  of  a 
Christian  hero ;  for  the  path  that  leads  to  this  high  goal  is 
througfh  self-denial  and  an  unreserved  devotion  to  the  care  of 
the  sick."  Ghouls,  harpies,  and  vampires  may  wear  his  title 
and  usurp  his  place  even  as  the  false  prophet  "  steals  the 
livery  of  heaven  to  serve  the  devil  in ;  "  but  they  feast  upon 
the  credulity  of  the  ignorant  only.  They  are  never  found  in 
the  haunts  of  poverty,  speaking  words  of  comfort  and  admin- 
istering to  the  bodily  needs  of  those  stricken  with  disease. 
The  nobility  of  our  profession  recognizes  no  nationality,  no 
creed,  no  condition  of  life.  It  is  founded  on  the  broad  basis 
of  Christian  philanthropy.  It  unfurls  its  banner  and  marches 
to  the  fulfilment  of  its  mission  of  love  and  mercy,  heedless  of 
reward — unmindful  of  everything  but  duty.  It  is  neither 
swayed  by  the  formalities  of  society  nor  dismayed  by  the  con- 
vulsions of  popular  sentiment. 

A  few  words  more  and  I  am  done — do  not  forget  that  you 
are  only  at  the  threshold  of  your  profession — would  you  be 
successful,  you  must  continue  unceasingly  to  study;  would  you 
achieve  fame,  study  must  be  your  watchword  ;  would  you  be 
worthy  of  the  high  calling  you  have  chosen,  study  must  fill 
your  every  moment.  In  the  wide  domain  of  useful  and  dig- 
nified employments  there  is  none — no,  not  one — in  which  the 


ESSAYS  AND  ADDllESSICS.  159 

Held  iKifoic  the  Hlii(](!nt  i.s  ho  broad,  ho  over  oxtendin^r  in  its 
liorizoii.  JOreot  Cor  yoiir.sclC  an  ideal  of  aeliievcment  and 
steadily  march  toward  it,  ho  Hhalj  it  he  that  vve  whf)  hen;  to- 
night wehiorne  you  at  IhegatcHoF  the  temple  will  in  thr;  future 
be  among  your  proudest  admirers  when  you  nhall  have  rearihed 
that  distinction  in  its  council  whi<'h  yon  will  then  have  de- 
served. And  now,  with  heartfelt  wishes  for  your  hapj)ine8S 
and  success,  I  bid  you  God-speed. 


EULOGY 


DELIVERED  BY  THE   PRESIDENT    OF  THE  MEDICAL    SOCIETY 
OF  THE  DISTRICT  OF  COLUMBIA,  FEBRUARY  14,    1877. 

Gentlemen  :  It  becomes  my  painful  duty  to  announce 
to  you  the  death  of  one  of  our  most  distuiguished  members. 
Dr.  William  Beverly  Drinkard  died  at  his  residence  in  this 
city  on  the  morning  of  the  13th  instant,  after  a  brief  but 
painful  illness.  Under  ordinary  circumstances  I  might  be 
content  with  this  simple  official  announcement;  but  as  one 
of  those  who  were  near  him  during  his  last  illness,  and  who 
enjoyed  his  friendship  and  confidence,  I  am  not  permitted  to 
grieve  in  silence.  I  cannot  withhold  a  tribute  to  the  memory 
of  one  so  honored  and  so  loved  as  was  our  late  lamented  asso- 
ciate. He  was  distinguished,  as  a  man,  for  his  uniform  court- 
esy, unswerving  integrity,  and  honorable  bearing ;  a«  a  phy- 
sician, for  his  learning,  his  skill  and  devotion  to  duty  ;  and  as 
a  brother  practitioner,  for  his  urbanity,  courteous  bearing,  and 
high  regard  for  the  ethics  of  professional  intercourse.  None 
knew  him  but  to  love  him,  and  the  better  one  knew  him  the 
more  he  was  loved.  There  is  not  one  in  yonder  grief-stricken 
household,  nor  here  among  the  companions  of  his  manhood, 
nor  elsewhere  among  his  numerous  friends,  who  ever  heard 
him  utter  one  harsh  word  or  one  unmaulv  thoucrht. 


160  ^  ESSAYS  AND  ADDRESSES. 

As  lie  lived,  so  he  died.  That  courtesy  and  punctilio  which 
characterized  his  demeanor  toward  everyone ;  that  firm  and 
heroic  will  which  had  so  pre-eminently  distinguished  his  career 
from  the  begluulug  of  his  professional  studies,  and  those  high 
social  and  iatellectual  qualities  which  had  surrounded  him 
with  so  many  friends,  never  forsook  him,  and  never  (once) 
yielded  under  the  painfid  suffering  which  terminated  in  death. 
But,  perhaps,  I  can  better  illustrate  his  heroism  by  a  narra- 
tion of  some  of  the  incidents  of  his  sickness  and  death.  From 
the  commencement  of  his  illness  till  within  a  few  minutes  of 
his  death  he  retained  all  his  faculties  and  never  once  lost  his 
self-possession  or  forgot  his  calling.  He  understood  the  nature 
of  his  disease,  marked  its  progress,  realized  its  danger,  and 
lent  every  assistance  to  his  medical  advisers,  which  physical 
suffering  would  permit,  that  was  deemed  conducive  to  a  favor- 
able issue.  During  Friday  night,  when  his  temperature  was 
running  high  and  exhaustion  was  threatening,  previous  to 
taking  some  wine  (he  had  never  tasted  any  alcoholic  beverage), 
he  took  his  temperature  and  reading  it  at  104.5°  drank  the 
champagne.  After  awhile  he  again  took  his  temperature,  and, 
returning  the  instrument  to  me,  remarked,  '^A  primary  eleva- 
tion of  0.8°."  When  the  time  came  to  repeat  the  stimulant 
he  again  examined  his  temperature;  finding  a  decline,  took 
the  wine ;  and  so  at  several  recurring  periods  did  he  make 
the  thermal  observation  before  repeating  the  draught.  Dur- 
ino-  the  early  part  of  this  scene  he  invited  attention  to  his 
most  distressing  symptoms,  and  several  times  recalled  the 
suggestion  of  Juergensen  in  regard  to  the  management  of 
certain  emergencies  occasionally  incident  to  the  course  of 
catarrhal  pneumonia.  As  early  as  Friday  night  he  indicated, 
but  not  until  Sunday  at  noon  did  he  positively  express,  any 
appreciation  of  an  unfavorable  result.  At  that  time  he  com- 
municated his  wish  to  have  an  interview  with  a  friend  then 
absent  from  the  city,  and  gave  explicit  directions  how  to 
reach  the  gentleman  by  telegraph,  but  added  if  it  could  be 
safely  deferred  until  the  next  day  he  was  content,  but  that 


KSSA  VS  AND  AD  D  It  h'SSKS.  ]  (;  1 

it  mtiHt  not  he  too  long  delayed  ;  and  then,  .scicining  to  fear 
the  opportunity  might  not  occur,  began  to  state  the  purposes 
of  tlu!  c(>nf('r(!nf!(!  desired,  (^casing  only  when  warned  of  the 
danger  of  fatigue.  Several  times  during  tlie  following  night 
and  succeeding  day  he  inquired  why  the  friend  had  not  ar- 
rived; and  when  finally  informed  that  he  could  not  reach  the 
city  before  6  A.M.  Tuesday,  he  seemed  to  dismiss  the  subject. 
Early  Monday  morning,  in  response  to  the  inquiry  of  a  rela- 
tive who  had  just  returned  to  his  room,  he  said,  with  his 
accustomed  suavity  of  manner  and  usual  precision  of  lan- 
guage, "  I  am  better.  The  night  was  one  of  intense  suffer- 
ing. I  am  not,  however,  out  of  danger."  The  hope  proved 
delusive.  Soon  the  aggravation  of  the  symptoms  denoted  ex- 
tension of  disease.  Thenceforward  until  the  end  there  was 
unabated  suffering  and  increasing  exhaustion. 

AVhen  the  hour  of  6  Tuesday  morning  had  come  he  re- 
minded me  that  his  friend  had  not  arrived,  but  waited  still 
awhile,  hoping  the  carriage  awaiting  his  arrival  at  the  depot 
might  bring  him.  Then  calling  me  to  his  bedside  he  inquired 
if  everything  had  been  done,  and  having  been  informed  that 
our  resources  had  been  exhausted,  he  said,  ''  It  will  be  too 
late.  It  must  be  manifest  to  you  that  I  am  dying.  For 
four  days  I  have  struggled  against  this,  but  it  is  no  use;  the 
end  is  near.     I  must  intrust  to  you  what  I  Avished  to  have 

said  to ."     Thus  he  began,  and  with  marked  deliberation, 

calmness,  and  clearness  he  communicated  his  requests.  This 
interview  having  been  concluded  he  asked  for  his  mother, 
who  immediately  entered  his  chamber  from  the  adjoining 
room.  I  know  not  what  passed,  but  in  bidding  her  good-by 
he  said:  '^  Mother,  next  to  the  immediate  family  hold  these 
friends  who  have  been  with  me  during  my  illness  forever 
in  affectionate  remembrance."  Next  he  called  his  sister  and 
brother's  wife,  and  then  the  brothers,  one  by  one ;  to  each  he 
spoke  words  of  comfort,  and  bade  each  an  affectionate  and 
final  farewell.  Pausing  a  moment  and  looking  away  he  sud- 
denly turned  toward  a  brother  presenting  the  infant  nephew, 

11 


162  ESSAYS  AND  ADDRESSES. 

aud  with  outstretched  arms  he  bade  Joe  come  to  him,  clasped 
him  in  his  arms,  kissed  him,  and  returned  him  to  his  father. 
Next  came  the  interview  with  a  lady  whom  he  held  in  high 
esteem,  who  had  remained  with  him  during  his  illness,  ren- 
dering valuable  assistance  and  offering  consolation  to  the 
afflicted  family.  And  now  came  tottering  to  his  bedside  the 
old  family  servant.  He  grasped  her  hands  and  said  :  ''  You 
nursed  me  during  my  infancy,  and  have  always  been  faithful 
to  me.  I  do  not  wish  to  die,  but  it  is  so,"  and  drawing  her 
to  him  kissed  her  and  bade  her,  too,  a  final  good-by.  He 
alone  passed  through  this  trying  and  affecting  scene  unmoved. 
Not  once  did  his  voice  falter,  never  for  one  moment  did  he 
lose  himself  ;  but  all  his  utterances  were  delivered  with  such 
calmness  as  I  had  never  witnessed.  After  resting  for  a  time, 
seeming  to  be  reflecting  whether  anyone  had  been  omitted, 
he  asked  for  Dr.  Coues,  the  companion  of  his  boyhood  and 
firm  friend  of  his  matured  years;  and  to  him,  when  parting, 
he  said,  ''  Present  my  compliments  and  regards  to  Mrs. 
Coues."  Subsequently  he  inquired  for  the  family,  and  when 
told  they  were  in  the  adjoining  room  he  bade  me  tell  them  to 
''  remain  there  and  be  at  his  bedside  when  he  died."  Later 
still  he  offered  recognition  to  a  valuable  friend  who  had  been 
hastily  summoned  to  his  dying-chamber.  When  all  this  had 
passed  the  mental  aberrations  of  rapidly  approaching  death 
began.  With  an  occasional  irrelevant  inquiry  concerning  some 
patient  and  the  giving  of  precise  directions  to  another  he  lin- 
gered on ;  when  suddenly,  seeming  to  repossess  himself,  he 
exclaimed,  "  Au  revoir,"  and  died,  surrounded  by  his  family 
and  friends. 


ESSAYS  y\NI)  A  DDIih'S.Sh'S.  163 


THE  COLUMBIA  HOSPITAL  AND  LYING-IN 
ASYLUM. 

THE    COLUMBIA    HOSPITAL    AND     LYING-IN    ASYLUM,    A 

GOVERNMENT    INSTITUTION  :     ITS    PAST    AND 

PRESENT   MANAGEMENT.      1877. 

TiTE  Act  to  "  incorporate  the  Women's  Hospital  Associa- 
tion of  the  District  of  Columbia"  was  passed  by  Congress 
and  approved  June  1,  1866. 

The  following  are  the  more  important  provisions  of  this 
Act: 

That  the  object  of  the  Association  hereby  incorporated  "  is 
to  found  in  the  city  of  Washington  a  hospital  and  dispensary 
for  the  treatment  of  diseases  peculiar  to  women  and  a  lying-in 
asylum,  in  which  those  unable  to  pay  therefor  shall  be  fur- 
nished with  board,  lodging,  medicine,  and  medical  attendance 
gratuitously,  and  to  that  end  full  powers  are  hereby  conferred 
on  the  Association."     (Sec.  5.) 

That  the  "  affairs  of  said  corporation  shall  be  under  the 
control  and  management  of  a  board  of  twelve  directors  (con- 
sisting in  the  beginning  of  the  first  twelve  of  the  incorpo- 
rators named  in  the  Act)  or  such  further  number  as  the  duties 
of  the  incorporation  may  require."     (Sec.  3.) 

That  said  corporation  shall  have  "  power  to  accept,  pur- 
chase, receive  conveyances  of  and  hold  property,  either  per- 
sonal or  real,  to  an  amount  necessary  for  the  full  accommo- 
dation, convenience,  and  support  of  the  institution  and  those 
participating  in  its  benefits."     (Sec.  6.) 

That  Congress  shall  have  power  to  ''alter,  amend,  or  re- 
peal" the  Act  "  at  any  time  hereafter."     (Sec,  8.) 

In  the  sundry  civil  appropriation  bill  for  1872  there  was 
appropriated  "  for  purchase  of  the  building  now  occupied  by 
said  hospital,  with  forty  thousand  feet  of  ground,  twenty- 


164  ESS  A  YS  AND  ADDRESSES. 

five  thousand  dollars:  Provided,  That  the  title  of  said  real 
estate  shall  be  vested  in  the  United  States  for  the  use  of  said 
hospital,  and  that  no  part  of  the  real  or  personal  property 
now  held  or  hereafter  to  be  acquired  by  said  institution  shall 
be  devoted  to  any  other  purpose  than  a  hospital  for  women  and 
a  lying-in  asylum  without  the  consent  of  the  United  States." 

These  extracts  from  the  charter  determine  definitely  the 
objects  of  the  institution,  and  the  above  clause,  quoted  from 
the  sundry  civil  appropriation  bill  of  1872,  fixes  the  owner- 
ship of  the  "  real  or  personal  property  now  held  or  hereafter 
to  be  acquired  by  said  institution  "  in  the  Government  of  the 
United  States.  If  anything  further  was  necessary  to  settle 
ultimately  the  rightful  ownership  of  the  institution,  the  an- 
nual appropriations  made  by  Congress  for  its  maintenance 
and  support  might  be  cited. 

Statement  of  annual  appropriations  by  Congress  for  the 
institution:  1866,  $10,000;  1867,  $10,000;  1868,  not  ob- 
tained—probably $10,000;  1869,  $15,000;  1870,  $10,000; 
1871,  $18,000;  1872,  $18,500;  1873,  52,000  ;  1874,  $28,- 
500;  1875,  $32,500;  1876,  $24,000  —  total,  $217,000. 
Aggregate,  including  1868,  $227,000. 

This  amount  does  not  include  the  sums  (nor  the  sums  con- 
tributed by  the  city  government,  which  were  considerable) 
annually  received  from  ^' pay -patients,"  which  are  unknown 
quantities,  never  having  been  paid  into  the  United  States 
Treasury,  or  in  any  manner  accounted  for.  ISTeither  the 
Government  of  the  United  States,  which  has  been  its  munifi- 
cent almoner  from  the  beginning,  nor  the  public,  for  whose 
benefit  it  was  created,  have  any  knowledge  whatever  of  the 
amount  of  money  received  from  ''  pay -patients  "  nor  how  it 
has  been  expended. 

Now  that  it  has  been  shown  that  the  institution  belongs 
(the  claim  of  a  portion  of  the  directory  to  the  contrary  not- 
withstanding) to  the  Government  of  the  United  States,  the 
next  inquiry  that  presents  itself  is  :  Has  its  management 
been  proper  and  commendable  ? 


yiVS'.SVl  J  W  A  ND  A  Dim  ICSSES.  1  r,5 

The  clisu'tcr  doclams  tlio  ))iirj)OH(!  of  tin:  yVsHofiiation  to  be 
to  ''  found  in  the  city  of  Washiii'^ton  a  hospital  and  diHj)f:n- 
sary  for  the  treatment  of  Ax&QdifmH  peculiar  to  wonif-n,  and  a 
lyin!j:;-in  asyhim  ;"  y(!t  nnmbors  of  women  siiffcrinji;  from  din- 
oases  not  "  peculiar  "  to  the  sex  have  been  admit  ted  to  its 
wards.  Cases  of  consumption,  pneumonia,  hiji-joint  disease, 
malarial,  typhoid,  and  remittent  fevers,  and  other  aff'-etions 
equally  objectionable  to  the  proper  hygienic  conditions  of  a 
lying-in  asylum  have  been  admitted. 

Chapter  XII.  of  the  ''  By-laws  and  Regulations,"  now  in 
force,  reads  as  follows:  '^  Patients  will  be  admitted  to  private 
rooms  in  the  institution  on  payment  of  not  less  than  §6  per 
week,  the  amount  to  vary  with  the  room  occupied  and  the 
attendance  required.  Board  payable  weekly  in  advance.  This 
includes  medicine,  medical  and  surgical  attendance." 

The  amount  charged  varies  from  $6  to  $10  a  week  in  an 
institution  owned  and  supported  by  the  general  government, 
which  has  declared  its  object  to  be  ''  to  found  in  the  city  of 
Washington  a  hospital  for  the  treatment  of  diseases  peculiar 
to  women  and  a  lying-in  asylum,  in  which  those  unable  to  pay 
therefor  shall  be  furnished  with  board,  lodging,  medicine,  and 
medical  attendance  gratuitously. "  The  Congress  of  the  United 
States  did  not  contemplate,  nor  does  the  language  of  the  char- 
ter authorize,  the  establishment  of  a  boarding-house  for  the 
reception  of  women  sick  with  diseases  peculiar  to  the  sex  or 
pregnant ;  yet  the  management  has  so  construed  Sec.  5  of  the 
Act  of  incorporation,  and  claims  that  this  feature,  thus  en- 
grafted upon  the  institution,  has  transformed  it  into  a  private 
hospital,  which  can  be  conducted  irrespective  of  the  rights  of 
the  general  government  and  without  responsibility  for  the 
sums  of  money  received  from  this  source.  The  number  of  pay- 
patients  is  probably  never  less  than  one-fifth,  and  occasion- 
ally may  reach  one-third  of  the  daily  average  of  patients  in  the 
institution.  The  daily  average  of  patients  for  any  year  since 
1866  has  not  probably  exceeded  thirty,  which,  at  the  maxi- 
mum charge  of  SIO  per  week  for  board,  lodging,  medicine, 


166  ESSAYS  AND  ADJDEESSES. 

and  medical  attendance,  would  make  the  daily  cost  about 
$43,  or  nearly  $16,000  a  year.  Yet  in  1875  Congress  appro- 
priated $32,500  exclusive  of  the  amount  received  from  pay- 
patients,  which,  upon  the  same  basis  of  calculation  (one-fifth 
of  the  daily  average  of  patients  at  $10  per  week),  would  amount 
to  $3,131,  which,  added  to  the  appropriation  by  Congress, 
would  make  $35,631  expended  for  the  support  of  a  daily 
average  of  thirty  patients  for  one  year,  or  $1,187  for  each 
patient  per  annum.  These  calculations  are  based  upon  a  high 
daily  average  of  patients  at  the  maximum  cost  of  pay-patients 
fixed  by  the  by-law  previously  cited.  But  it  must  be  mani- 
fest that  a  number  of  the  pay-patients  (perhaps  at  all  times 
one-half  of  their  number)  do  not  pay  more  than  $6  per  week, 
a  sum,  it  seems,  deemed  by  the  authorities  adequate  to  cover 
cost  of  "  board,  lodging,  medicine,  and  medical  attendance;" 
and  therefore  a  rate  which  should  cover  the  cost  of  maintain- 
ing the  pauper  patients  in  an  institution  free  from  rent, 
' '  taxes,  and  assessments. "  If  the  cost  of  each  patient  per 
annum  had  been  estimated  upon  the  basis  of  $6  per  week,  it 
would  not  have  been  half  the  amount  previously  named  as 
the  apparent  cost  per  annum  per  patient.^  There  need,  how- 
ever, be  no  speculation  as  to  the  daily  average  or  daily  costs 
of  patients ;  for  during  the  past  eighteen  mouths  the  number 
of  patients  in  the  house  has  been  recorded  daily,  and  Con- 
gress can  require  the  resident  physician  to  produce  the  record. 
With  these  data  and  the  aggregate  amount  of  expenditures 
during  the  same  period,  any  tyro  can  ascertain  the  average 
daily  cost  of  each  patient  in  money,  to  which  should  be  added 
the  wear  and  tear  of  the  luxurious  and  costly  furniture  which 
adorns  certain  apartments.  It  will  doubtless  not  be  so  easy  to 
ascertain  the  number  of  pay-patients  or  the  amount  of  money 
which  they  have  paid  into  the  treasury  of  the  institution. 


1  A  daily  average  of  thirty  patients,  including  the  pay  and  fee,  at  a  weekly  cost  of 
86  for  each  patient,  would  make  the  weekly  cost  1180,  or  8^9760  per  annum  ;  whereas 
in  1876  Congress  appropriated  $24,000,  exclusive  of  the  amount  received  from  the 
"pay-patients." 


A'-S'-S'.l  r,S'  A  Nit  AhDRKHSES.  107 

Many  of  these  pay-puticnts  cariic  from  ilio  States;  whether 
broiiglit  thither  by  members  and  Senators  or  attracted  by  the 
amhi!i;iious  reputation  of  its  recent  chief  mcdifal  ofTu-fr,  can- 
not of  course  be  ascertained. 

In  view  of  the  extra va<^ant  expenditures  made  m  support 
of  this  institution  and  with  the  purj)ose  to  correct  a  manifest 
abuse,  a  number  of  physicians  resicb'ng  in  this  city  and  con- 
nected with  other  hospitals  and  medical  institutions,  })resented, 
through  Mr.  Stevenson,  of  Illinois,  to  the  first  session  of  the 
Forty-fourth  Congress,  a  bill  entitled  ''A  bill  to  abolish  and 
to  establish  a  new  Board  of  Health  for  the  District  of 
Columbia,  and  for  other  purposes"  (House  bill  No.  3194), 
which  contains  the  following  provision,  Section  7:  ''That 
all  appropriations  made  by  Congress  for  the  support  of  any 
hospital,  either  in  whole  or  in  part,  shall  be  disbursed  under 
the  direction  of  the  Surgeon-General  of  the  United  States 
Arnay  :  Provided,  That  the  rates  allowed  by  him  shall  not 
exceed  one  dollar  per  day  for  each  patient  actually  treated  in 
each  hospital,"  and  providing  further,  in  Section  8,  "  that  no 
salary  shall  be  paid  to  any  medical  officer  other  than  the 
resident  physician  connected  with  any  hospital  supported  in 
whole  or  in  part  by  the  Government  of  the  United  States." 
The  allowance  of  one  dollar  per  day  was  based  upon  the 
ascertained  cost  of  each  patient  per  day  in  the  army  hospi- 
tals and  upon  the  contract  made  by  the  government  with  the 
authorities  of  Providence  Hospital  for  the  maintenance  of 
the  transient  sick  paupers,  for  which  Congress  for  many 
years  has  made  annual  appropriations.  If  the  government 
can  maintain  sick  soldiers  at  a  cost  not  exceeding  one  dollar 
per  day,  and  transient  sick  paupers  at  a  cost  not  exceeding 
six  dollars  per  week,  why  must  it  pay  more  than  three  dol- 
lars per  day  (including  those  who  are  supposed  to  defray 
their  own  expenses)  for  each  patient  in  its  hospital  for  ' '  dis- 
eases peculiar  to  women  and  a  lying-in  asylum  ?  " 

To  recur  to  the  charter.  By  Section  3  the  number  of  direc- 
tors is  limited  to  twelve,  ''  or  such  further  number  as  the 


168  ESSAYS  AND  ADDRESSES. 

duties  of  the  corporation  may  require/'  and  Regulation  1, 
Chapter  I.,  prescribes  that  the  "  board  of  directors  shall  con- 
sist of  not  more  than  fifteen  members,  with  one  Senator  and 
two  Representatives  added  to  it  by  Act  of  Congress."  The 
charter  and  the  by-law  passed  in  pursuance  thereof  are  in- 
definite in  regard  to  the  number  of  directors.  Section  2  con- 
fers authority  upon  the  board  ''  to  fill  all  vacancies  created 
by  death,  resignation,  or  otherwise,"  and  the  by-law,  Cliapter 
I.,  prescribes  that  "  vacancies  occurring  in  the  board  may  be 
filled  at  any  regular  meeting,"  The  number  is  indefinite ; 
the  terms  of  service  are  unlimited,  and  the  majority  of  a 
quorum  (seven)  possesses  the  power  to  fill  vacancies  at  any 
regular  meeting,  so  that  the  controlling  influence  can  main- 
tain its  ascendancy  forever  by  filling  or  not  filling  vacancies, 
or  by  increasing  the  number,  as  may  best  suit  and  secure 
their  purposes,  objects,  and  aims.  Such  provisions  of  law 
are  against  public  policy,  contrary  to  the  usages  of  the  gov- 
ernment, demoralizing  in  their  tendencies,  and  conduce  inevi- 
tably to  the  formation  of  cliques,  combinations,  and  rings, 
which  accept  any  opportunity  to  promote  their  ulterior  pur- 
poses. No  banker  or  capitalist  would  engage  in  an  enter- 
prise, with  or  without  a  charter,  which  vested  all  authority 
in  a  board  of  managers  indefinite  in  number,  with  unlimited 
terms  of  service,  and  with  indefinite  power  to  increase  its 
number  or  fill  its  vacancies.  Honesty  is  very  prone  to  cease 
where  responsibility  terminates.  The  consonance  between 
the  language  of  the  charter  and  the  by-laws  passed  in  pur- 
suance thereof  clearly  manifests  the  animus  which  prompted 
the  authors  of  the  enactment  to  clothe  the  powers  conferred 
upon  the  Association  in  language  so  unusual  and  peculiar. 
He  or  they  projected  a  great  corporation  to  be  held  in  per- 
petuity by  themselves,  their  heirs  and  assigns.  This  might 
be  tolerated  or  excused  if  any  one  of  the  directors  had  ever 
contributed  one  penny  toward  defraying  the  expenses  of  the 
establishment  or  owned  a  farthing's  worth  of  the  property. 
Even  the  pen,  ink,  and  paper  with  which  their  acts,  if  at  all, 


.I<JS,Sy\yS  ANP  ADltlU'JSSKS.  ]nO 

nro  recorded  nro.  drawn  from  tlio  snpplicH  of  (he  interior  de- 
partment, and  even  the  printing  of  letter- heads,  et<,',,  is  done 
at  the  government  printing  oiTiee.  The  addition  to  the  board 
of  a  Senator  and  two  Rcjpresentative.s  by  Aet  of  CV)ngreHH  in 
1872  was  another  of  tlio.se  ingenious  devices  to  promote  the 
aims  of  ring  management;  for  it  was  easy  to  secure  the  selec- 
tion of  friends  who  would  stand  sponsors  for  them  on  the 
floors  of  the  two  Houses  of  Congress. 

In  this  connection  it  is  proper  to  allude  to  the  manner  in 
which  the  directors  conduct  business  at  their  meetings.  When- 
ever anything  is  to  be  accom]:)lishGd,  as  for  instance  the  elec- 
tion of  officers,  a  member  who  is  advised  of  the  purpose  to  be 
attained  moves  the  appointment  of  a  committee,  sometimes 
naming  the  members  thereof,  who  shall  make  the  nomina- 
tions for  the  officers,  and  their  report  is  adopted  without 
allowing  an  opportunity  to  the  minority  to  express  by  vote 
or  otherwise  their  preference  for  others.  Thus  the  president. 
General  0.  E.  Babcock,  the  champion  engineer  of  whiskey 
rings,  and  his  coterie  of  adherents  have  perpetuated  their 
administration  of  the  affairs  of  the  Association. 

The  most  important  portion,  however,  of  the  histor}*  of 
this  national  lying-in  asylum  pertains  to  its  medical  manage- 
ment. To  Dr.  J.  Harry  Thompson^  is  due  the  credit  of 
conceiving  the  project  and  engineering  the  bill  through  Con- 
gress, incorporating  the  Association.  He  has  enjoyed  the 
honor,  discharged  the  duties,  aud  reaped  the  rewards  of 
the  office  of  surgeon -in-chief  from  its  organization  until  the 
20th  of  September  last.  Until  the  fall  of  1875  he  was  prac- 
tially  the  active  and  chief  fiduciary  officer,  as  well  as  the 
trusted  surgeon  of  the  institution.  To  him  has  been  awarded 
the  merit  of  securing  the  extraordinary  appropriations  from 
the  treasury  of  the  United  States,  and  in  his  person  were 
combined  the  major  domo  aud  factotum  of  the  establishment, 

1  The  individual  who  has  registered  himself  on  the  roster  of  the  Medical  Society 
of  the  District  of  Columbia  as  a  graduate  of  the  College  of  Physicians  and  Surgeons . 
London,  but  whom  the  seeretarv  of  that  iustitutiou  declares  is  not  a  member. 


170  ESSAYS  AXD  ADDBESSES. 

who  purchased  and  dispensed  with  lavish  generosities  the 
supplies,  hospital  stores,  and  necessary  appurtenances.  Dur- 
ing the  year  1875  the  Board  of  Directors,  impelled  by  the 
force  of  public  opinion  and  the  widespread  rumors  of  wrong- 
doing, took  measures  at  the  annual  meeting  in  September  to 
reorganize  the  management  of  the  institution,  which  culmi- 
nated in  December  in  the  adoption  of  a  code  of  regulations 
which  legislated  Dr.  Thompson  out  of  the  direction  and  off 
the  important  committees ;  took  from  him  the  appointment 
of  the  resident  physician  and  matron ;  curtailed  his  authority 
over  the  subordinates ;  and  deprived  him  of  the  power  of 
purchasing  hospital  stores  and  supplies.  At  the  same  time 
he  was  retained  as  surgeon-in-charge  with  a  salary  of  $2000 
per  annum.  The  office  of  assistant  surgeon  was  abolished, 
and  at  the  same  time  there  was  organized  an  "  advisory  and 
consulting  board  of  physicians  and  surgeons,"  to  consist  of  not 
more  than  eight  medical  gentlemen  residing  in  the  District  of 
Columbia.  This  board  was  required  (by  Regulation  4,  Chap- 
ter IX.)  to  '^  present  at  each  annual  and  semi-annual  meeting 
to  the  Board  of  Directors,  through  their  secretary,  a  report 
of  the  medical  and  surgical  service  of  the  hospital,  with  such 
recommendations  in  regard  to  securing  its  greater  economy 
and  efficiency  as  their  observation  may  warrant.  In  addi- 
tion to  these  reports,  communication  upon  those  and  kindred 
topics  by  the  Advisory  Board,  or  a  majority  of  those  on  duty, 
will  be  received  by  the  Board  of  Directors  through  their  sec- 
retary at  any  regular  meeting  and  respectfully  considered." 
In  addition  they  were  made  ''counsellors"  and  required 
(one-fourth  being  on  duty  for  three  months  in  each  year)  to 
visit  the  hospital  "  once  during  each  week,"  and  at  each 
visit  to  "  report  in  writing,  in  a  book  kept  for  that  purpose, 
the  condition  of  the  patients  and  building."  It  was  further 
provided  that  "  no  capital  operation  shall  be  performed, 
except  in  cases  of  urgent  necessity,  without  the  approbation 
of  at  least  three  of  the  consulting  board."  These  were 
wise,  judicious,  and  needful  regulations,  exhibiting  a  spirit  of 


ESS  A  YS  AND  ADD  It  KSSES.  J  7  i 

reform,  believed  at  tlie  time  to  he.  sincere,  and  evincing  a  wish 
to  prohibit  and  mitigate  abuses  admitted  to  exist  by  the 
enforced  revision  of  their  regulations  and  thf;  adojttion  of 
the  ])rohibi(ory  by-laws. 

The  advisory  and  consulting  board  entered  upon  tlu;  dis- 
charge of  the  duties  required  of  them,  as  set  forth  in  the  fore- 
going extracts  from  the  regulations;  and  in  September,  after 
nine  months'  service  and  observation,  submitted  to  the  annual 
meeting  of  the  Board  of  Directors  a  report  in  writing,  "  with 
such  recommendations  in  regard  to  securing  its  greater  econ- 
omy and  efficiency  as  their  observation  "  warranted.  These 
recommendations  were  referred  to  a  special  committee,  organ- 
ized in  the  customary  manner  by  resolution  naming  the  three 
constituents,  xlfter  several  months'  deliberation  the  committee 
reported  to  the  directors  December  21,  1876.  This  report 
succinctly  sets  forth  both  the  recommendations  made  by  the 
advisory  and  consulting  physicians  and  those  submitted  by 
the  special  committee  of  the  directors,  and  it  was  adopted. 
These  propositions  will  be  considered  seriatim. 

''  The  first  resolution  recommended  by  the  consulting  board 
is  in  these  w^ords: 

"  At  the  request  of  the  surgeon-in-chief  the  visiting  physi- 
cians and  surgeons  may  visit  any  particular  patient  as  often 
as  he  (the  surgeon-in-chief)  may  desire  them;  but  in  no  case 
shall  the  surgeou-in-chief  elect  others  than  the  visiting  physi- 
cians and  surgeons  to  make  such  visit.  All  consultations 
shall  be  confined  to  members  of  the  consulting  board,  and 
no  surgical  operation  shall  be  performed  except  by  the  sur- 
geon-in-chief, or,  at  his  request,  by  some  member  of  the 
advisory  board." 

This  resolution  the  committee  recommended  the  board  to 
approve,  with  the  addition  of  the  words  ''  except  by  request 
of  the  patient  and  with  the  approbation  of  the  visiting  jyhysi- 
oians  and  surgeons,"  to  the  sentence  ending  with  the  words 
*'  such  visits  ;"  the  insertion  of  the  w^ords  "  except  as  above 
provided"  after  the  words  '^consulting  board"  in  the  next 


172  ESSAYS  AND  ADDRESSES. 

seutencoj  aud  the  addition  of  the  following  words  at  the  con- 
clusion of  the  resolution:  "  or  other  fully  recognized  members 
of  the  profession  and  with  the  approbation  of  the  consulting 
hoard.'' 

It  must  be  manifest  to  the  most  casual  reader  that  the 
object  of  the  advisory  and  consulting  physicians,  in  making 
the  recommendation  set  forth  in  the  resolution  above,  was  to 
prohibit  existing  irregularities  in  the  medical  management  of 
patients ;  but  the  amendments  suggested  by  the  committee 
and  approved  by  the  directors  not  onh''  failed  to  accomplish 
the  object,  but  practically  clothed  the  surgeon-in-chief  with 
extraordinary  authority  and  power  to  secrete,  conceal,  and 
hide  a  patient  in  the  house ;  for  in  a  subsequent  amendment 
it  is  provided  'Hhat  no  private  patient  shall  be  visited,  ex- 
amined, or  prescribed  for  by  other  than  the  surgeon-in-chief, 
unless  by  special  request  of  such  patient  and  in  consultation 
with  the  surgeon-in-chief."  Can  it  be  that  the  Government 
of  the  United  States  has  established  and  supports  an  institu- 
tion in  which  women  suffering  from  '^  diseases  peculiar  to 
their  sex  "  are  to  be  hidden  and  secluded  from  the  visits  and 
observations  of  any  other  than  a  surgeon  whom  the  directors 
may  select?  By  her  '^special  request"  she  may  be  visited 
by  another,  but  such  request  must  come  through  the  indi- 
vidual at  whose  will  she  is  thus  secluded. 

2.  ''  As  to  the  resolution  advising  the  removal  of  carpets 
from  all  sleeping-apartments  of  patients,  your  committee 
recommend  their  removal  from  all  rooms  used  for  lying-in 
purposes ;  but  that  they  be  for  the  present  allowed  to  remain 
in  such  private  rooms  not  used  for  such  purposes." 

The  object  of  this  recommendation  was  to  promote  the 
hygienic  conditions  of  the  house  as  well  as  in  the  interest 
of  economy;  but  it  was  unfortunately  in  contravention  of 
certain  speculative  tendencies,  and  carpets  purchased  at  prices 
varying  from  $2  to  $4  per  yard  contributed  amazingly  to  the 
welfare  of  impecunious  dealers. 

3.  '^  As  to  the  recommendation  to  admit  a  member  of  the 


ESS  A  YS  AND  A  DDIiHSSKS.  173 

consulting  hoard  to  ull  tlie  niectings  of  tlic  Jioanl  of  \)\rw,U)rH 
for  purpoHGH  of  mutual  consultation  and  explanation,  your 
committee  are  of  the  opinion  that  Hiu'ii  adinission  is  not  neces- 
sary or  advisable." 

Of  course  not.  It  is  not  probable  that  a  hoard  of  direr-tors 
which  had  empowered  its  surgeon-in-chief  to  seclude  and  hide 
a  sick  woman  at  his  will  and  pleasure  would  admit  to  its  de- 
liberations one  of  a  board  of  physieians  who  were  sf^eking  to 
prevent  such  an  act,  for  he  would  there  confront  them  and 
their  chosen  agent,  face  to  face,  and  be  a  living  wifness  of 
their  purposes  and  iutent. 

The  fourth  recommendation  related  to  a  conflict  between 
two  of  the  regulations,  which  was  corrected. 

5.  "  As  to  the  proposition  to  abolish  the  salary  of  the  sur- 
geon-iu-chief,  your  committee  are  of  the  opinion  that  this,  for 
the  present,  would  not  promote  the  interests  of  the  hospital. 
Arguments  and  considerations  that  would  be  of  great  force,  if 
this  were  a  hospital  for  general  purposes,  fail  when  we  con- 
sider the  prime  fact  that  this  is  a  hospital  for  special  purposes, 
requiring  special  capacities  and  skill  in  its  chief  medical  offi- 
cer. We  are  of  the  opinion  that  it  is  wise  for  the  Board  of 
Directors  to  retain  in  their  hands  the  power  each  year  to  reg- 
ulate and  fix  the  remuneration  of  its  medical  officers  according 
to  their  judgment  of  what  will  best  promote  the  prosperity  of 
the  hospital  at  that  time." 

If  the  committee  and  the  directors  had  stopped  with  the 
simple  denial  of  the  proposition  to  abolish  the  salary,  which 
was  in  exact  accordance  with  the  opinion  of  the  physicians 
connected  with  the  other  medical  institutions  and  charities  in 
the  city,  it  would  have  been  accepted  as  the  expression  of 
their  opinions,  perhaps  honestly  entertained ;  but  the  reasons 
assigned  clothed  their  refusal  with  a  ludicrous  gravity  only 
becoming  to  a  directory  that  would  invest  the  "  chief  medical 
officer"  of  a  ^'  hospital  for  special  purposes'"  with  power  to 
conceal,  hide,  and  seclude  from  observation  and  visits  sick 
women. 


174  ESSAYS  AND  ADDRESSES. 

The  sixth  "  recommeudatiou,  that  the  resident  physician  be 
appointed  after  a  competitive  examination  by  a  medical  board 
connected  with  the  hospital,  and  be  not  allowed  to  engage  in 
private  practice,"  but  required  to  devote  his  services  to  the 
hospital,  was  denied,  and  the  appointment  of  such  oificer 
transferred  to  the  surgeon-in-chief.  The  Government  of  the 
United  States  has  adopted  the  system  of  competitive  examina- 
tions for  the  admission  of  surgeons  to  the  medical  corps  of  the 
Army,  Navy,  and  Marine-Hospital  Service,  and  for  the  ad- 
mission of  cadets  to  the  West  Point  and  Naval  Academies ; 
yet  the  wisesacres  of  Columbia  Hospital  pronounce  this  sys- 
tem a  fallacy  and  a  wrong  when  sought  to  be  applied  to  a 
government  "  hospital  for  special  purposes  requiring  special 
capacities  and  skill,"  and  declare  "  its  chief  medical  officer" 
more  competent  to  select  his  subordinates  than  the  surgeon- 
generals  of  the  army,  navy,  and  marine-hospital  service  are 
to  select  the  members  of  the  medical  corps  serving  under 
their  direction.  The  reader  will  not  fail  to  recognize  the 
'^special  capacities  and  skill"  and  their  adaptation  to  the 
"  special  purposes"  of  either  ''the  chief  medical  officer"  or 
of  his  coadjutors,  who  must  be  credited  with  a  turgesceuce  of 
special  administrative  capacities. 

7.  ''As  to  the  recommendation  to  abolish  the  duties  (office) 
of  the  surgeon-in-chief  and  to  transfer  his  duties  to  a  medical 
staff,  if  this  were  a  general  hospital,  your  committee  might 
concur ;  but  as  this  is  a  hospital  devoted  to  special  purposes 
and  to  special  diseases  and  accidents,  we  are  of  the  opinion 
that  such  a  radical  change  would  be  unwise  and  disastrous 
to  the  best  interest  of  the  hospital,  and  therefore  recommend 
that  it  be  disapproved." 

In  consideration  of  the  fact  that  the  recommendation  of 
the  advisory  and  consulting  physicians  to  transfer  the  med- 
ical management  of  the  patients  to  a  corps  of  physicians  and 
surgeons  was  in  exact  accord  with  the  methods  in  successful 
operation  in  the  hospitals  throughout  this  country,  in  Eng- 
land, Ireland,   Scotland,  France,  and  perhaps  all  over  the 


ESSAYS  ANh  ADDRESSES.  176 

civilizod  worM,  tli<!  iiction  oC  IIk;  directors  in  rcjcftiiifr  tlic 
proposition  ])rove.s,  incontestably,  their  uttor  inr^apaoity  to 
rnanaji^c  tlie  iiistiiutioii  properly,  and  hii^^ohIh  a  most  fxtra- 
ordinary  Hnbscrvicncy  to  tiie  domination  of  unworthy  and 
improper  influences.  The  medical  reader  will  recognize  the 
comments  of  ''your  committee"  as  the  obHf>lete  dicta  of  a 
by-<:;one  period  and  the  mere  rep('titif)n  of  the  ''  argument 
and  considerations"  of  men  long  alTlicted  with  the  ''dry  rot." 
To  them  the  "  special  diseases  and  accidents"  of  women  are 
such  novelties  that  none  other  than  one  who  might  have  been 
dismissed  as  an  alarmist  from  an  army  in  active  operation 
could  possess  the  "  special  capacities  and  skill "  requisite  for 
their  treatment. 

8.  "  Your  committee  also  are  of  opinion  that,  unless  in 
cases  of  emergency,  no  examination  of  patients  can  be  made 
except  by  the  surgeon-in-chief  or  by  his  express  direction  in 
each  case,  with  such  of  the  consulting  board  as  he  may  select 
to  assist  him.  But  no  private  patient  shall  be  visited,  exam- 
ined, or  prescribed  for  by  other  than  the  surgeon-in-chief 
unless  by  special  request  of  such  patient  and  in  consultation 
with  the  surgeon-iu-chief." 

Human  nature  is,  fortunately,  a  very  variable  quantity  and 
subject  to  many  erratic  deviations  from  any  fixed  standard. 
It  is  not  always  easy  to  estimate  the  mental  calibre  or  to  in- 
terpret the  animus  of  men  by  their  written  words.  What 
this  paragraph  means  •seems  plain  enough,  but  what  could 
have  been  the  motives  which  prompted  a  board  of  directors 
in  charge  of  a  hospital  founded  by  a  beneficent  government 
for  the  care  aud  management  of  indigent  sick  women  to  call 
to  their  aid  a  board  of  advisory  and  consulting  physicians 
and  surgeons,  and  then  to  limit  their  examination  and  obser- 
vation to  "  cases  of  emergency"  and  such  others  as  the  sur- 
geon-in-chief might  direct  ?  How,  under  the  operations  of 
such  a  rule,  could  mistakes  in  diagnosis  and  in  treatment  be 
detected  and  prevented  ?  How  could  the  poor,  indigent  sick 
woman  be  saved  from  unnecessary  operations  and  mutilations 


176  ESSA  YS  AND  ADDBESSES. 

of  her  person  ?  It  couferred  upon  a  single  officer  absolute 
power  to  control  the  person  of  every  female  admitted  to  the 
hospital,  and  to  subject  her  to  such  treatment  as  might  suit 
his  whims,  caprices,  or  unfortunate  judgment  without  revi- 
sion or  examination  by  any  other  person  whomsoever.  Nay, 
more,  without  the  knowledge  of  any  other  than  such  ^'  as  he 
may  select  to  assist  him."  And  this  regulation  remains  in 
force  to-day,  the  written  evidence  of  audacious  wrong  and 
wilful  perversion  of  the  trust  confided  to  their  keeping. 
But  even  this  was  not  the  crowning  act.  They  struck  from 
Regulation  4,  Chapter  IX.,  before  quoted,  all  after  the  word 
hospital,  and  thus  forbade  the  advisory  and  consulting  physi- 
cians and  surgeons  from  making  any  "  I'ecommendations  in 
regard  to  securing  its  greater  economy  and  efficiency."'  And 
now  the  dawn  begins  to  illuminate  the  darkened  picture  and 
to  bring  into  view  its  hidden  features  and  emasculated  form. 
The  seclusion  of  patients ;  the  concealment  of  mistakes  and 
wrong-doing ;  the  lavish  expenditures  without  accountability  ; 
the  individual  self-aggrandizement ;  aud  the  subserviency  to 
the  behests  of  a  controlliug  ring  are  emblazoned  in  indelible 
characters  upon  the  illumined  canvas. 

This  series  of  amended  rules,  "  unanimously  approved  by 
the  Board  of  Directors,"  and  after  being  certified  to  by  "  O. 
E.  Babcock,  President,"  were  sent  to  the  Board  of  Advisory 
and  Consulting  Physicians  and  Surgeons,  No  one  will  be 
surprised  to  learn  that  they  all  resigned  (see  letter  of  resigna- 
tion dated  February  2,  1877) ;  but  many  medical  men  will 
grieve  to  know  that  others  sought  and  secured  appointment 
to  the  vacancies.  The  consulting  board,  however,  was  not 
filled  to  half  its  proper  number  until  the  annual  meeting  in 
September  last.  Soon  after  this  wholesale  resignation  of  the 
original  advisory  and  consulting  board  the  trusted  surgeon- 
in-charge  applied  for  and  obtained  a  leave  of  absence  for  six 
months  to  visit  Europe,  and  sailed  about  the  first  of  June. 
He  had  not  departed  from  the  shores  of  his  adopted  country 
before  rumor  credited  his  long-contemplated  visit  to  the  "  old 


J'JSSA  VS  A  N  l>  A  I)  l>  II  l':SSES  1  7  7 

horn('.st(!ii»l  "  on  the  Tliamos,  with  a  hojoiiiii  b'lyorid  t.li<;  reach 
of  invoHtij^atiiig  con  unit  toes,  and  Hp(!C(lily  ftamo  rnnioi'H  alHo 
of  intrigue  to  secure  th(!  contemplated  vacancy  in  the  office 
of  snr^eon-in-char<;c  of  the  liospital.  Our  comrriittee,  who 
had  so  exultantly  affixed  their  .signs-inanual  to  the  certificate 
attesting  his  ''  special  capacities  and  skill  " — which  certificate 
had  furthermore  been  unanimously  approved  by  their  coad- 
jutors and  certified  to  by  "  O.  E.  Babcock,  President" — 
began,  as  the  gamblers  say,  to  hedge  and  to  seek  some  path- 
way, hitherto  unknown  to  hospital  management,  by  which  to 
escape  from  the  dilemma  in  which  they  would  find  them- 
selves in  the  event  a  vacancy  should  occur  in  the  office  of 
surgeon-in-charge.  They  struck  out  boldly  for  originality. 
Competitive  examinations  and  division  of  labor  by  a  prop- 
erly arranged  and  selected  corps  of  physicians  and  surgeons 
(as  is  almost  the  universal  mode  of  hospital  management) 
were  to  them  obsolete  methods  and  inadequate  to  secure 
'^special  capacities  and  skill"  in  the  medical  officers  of  a 
hospital  ''devoted  to  special  purposes  and  to  special  diseases 
and  accidents."  And  so  it  may  be,  for  the  ''  special  pur- 
poses "  so  vividly  delineated  in  the  features  of  the  mongrel 
group  of  talismanic  characters  shown  on  the  illumined  canvas 
are  not  the  common  attributes  of  simple-minded  men,  but  the 
acquired  accomplishments  of  individuals  after  long  and  patient 
tuition  in  the  school  where  virtue  is  not  taught. 

The  directors  assembled  in  the  spacious  and  luxuriously 
furnished  office  at  the  hospital  building  on  the  night  of  the 
20th  of  September  last,  and  across  the  hallway  in  the  elegant 
parlor  sat  the  aspirants  for  coming  honors,  some  blushing 
with  hopeful  expectations  and  others  pallid  with  apprehen- 
sions of  disappointment,  but  all  merry,  like  poor  boys  at  a 
frolic,  for  Thompson — it  must  be  spelled  with  a  "  p" — had 
resigned  and  the  door-plate  had  been  removed. 

The  heavy  office-door  swung  to,  the  window-sashes  were 
fastened  down,  the  president,  enrobed  in  the  vestments  of  his 
office,  called  to  order,  and  the  members,  in  dignified  silence, 

12 


178  ESSAYS  AND  ADDRESSES. 

sat  erect  in  their  cushioned  chairs.  After  an  invocation  to 
the  Congress  of  the  United  States  for  a  continuance  of  its 
munificent  donations,  a  member  arose  and  with  oppressive 
gravity  announced  "  the  resignation  of  Dr.  J.  Harry  Thomp- 
son." Of  course,  it  was  referred  to  a  '^  special"  committee 
for  consideration  and  report.  The  resignation  was  accepted ; 
the  office  of  surgeon-in-charge  abolished,  and  the  duties  of 
the  office  transferred  to  the  resident  physician  on  condition 
that  he  would  supply  a  person  to  remain  in  the  building 
during  his  absence  in  attendance  upon  his  private  practice 
outside  of  the  hospital.  The  salary  of  the  resident  physician 
was  increased  from  $1000  to  |1800  per  annum  and  a  salary 
of  $1000  per  annum  was  voted  to  the  treasurer  of  the  insti- 
tution. Heretofore  the  office  of  treasurer  had  not  been  sala- 
ried ;  but  it  has  been  currently  reported  that  the  officer  had 
been  allowed  a  commission  for  disbursing  the  appropriation 
made  by  Congress,  which  was  paid  out  of  the  fund  derived 
from  the  "  pay-patients."  Recently  Mr.  Secretary  Schurz 
had  required,  in  accordance  with  the  law,  that  all  money 
received  from  this  source  should  be  paid  into  the  Treasury 
of  the  United  States ;  and  if  this  was  done,  commissions  could 
not  be  paid  to  the  treasurer,  as  the  accounting  officers  of  the 
United  States  Treasury  would  not  allow  them  in  the  account. 
The  payment  of  a  salary  was  the  device  to  circumvent  the 
action  of  the  secretary.  Will  the  honorable  secretary  submit  ? 
Will  the  people  of  this  country  silently  acquiesce  in  this 
impudent  defiance  of  authority  and  law  ?  Will  the  law- 
making power  permit  a  charter  to  continue  in  force  which 
sanctions  the  payment  of  salaries  to  its  officers  from  the 
national  treasury  in  direct  contravention  of  the  law  ? 

No  one  in  this  community  will  impugn  the  personal  in- 
tegrity of  the  resident  physician,  a  graduate  of  some  five 
years'  standing,  and  a  man  of  more  than  average  ability. 
His  friends  cherish  the  hope  that  he  will  prove  equal  to  the 
grave  responsibility  which  has  been  devolved  upon  him  ;  but 
others  have  quailed  under  less  responsibility  and  frittered 


ESS  A  YS  AND  A  DDIIESSES.  J  79 

away  golden  ()|)|)()rlijiiitic,s  under  iniprojxir  iiidiicncc.s.  Kor- 
tunatci  iii(l(!('(l  will  it  prove  for  the  iriHtitiition  if  lie  can  sur- 
mount tli(^  obs(a(;l(!,s  in  his  way  and  emerge  from  the  ruins 
unhaniied.  With  a  salary  of  .^1800  ])er  annum  ;  a  cornmiH- 
sarlat  suitable  to  the  most  refined  ttistes ;  all  the  appurte- 
nances of  a  spacious  dwelling;  the  use  of  a  library  and  an 
abundantly  snp|)lied  instrument-case,  together  with  the  privi- 
leges of  a  private  practice,  and  all  the  advantages  accruing  to 
an  institution  supported  by  the  bounty  of  the  general  gov- 
ernment, it  would  not  be  surj^rising  if  one  less  self-reliant 
and  capable  should  track  the  footprints  of  his  predecessor. 

But  the  old  rSgime  continues  in  possession;  the  previously 
cited  rules  and  regulations  remain  in  force.  To  the  reor- 
ganization of  this  management  the  medical  profession  of  this 
country  and  the  Congress  of  the  United  States  must  address 
themselves.  The  former  cannot  afford  to  hold  its  peace  and 
sit  idly  by  while  a  gigantic  corporation,  deriving  its  main- 
tenance from  the  common  treasury,  is  inviting  to  its  spacious 
wards  and  to  luxurious  ease  the  sick  women  from  all  parts 
of  tlie  country.  Nor  can  it  with  dignity  and  self-respect 
withhold  its  antagonism  to  an  institution  which  is  bringing 
dishonor  to  hospital  management.  To  this  end,  then,  it 
behooves  every  individual  member  of  the  profession  to  ap- 
peal to  his  representative  in  Congress  to  place  this  institu- 
tion mider  such  government  as  will  conduce  to  economy  and 
efficiency,  and  redound  to  the  honor  of  its  munificent  bene- 
factor and  to  the  credit  of  the  medical  profession.  Transfer 
the  appointment  of  the  directors  to  the  President  of  the 
United  States,  by  and  with  the  advice  and  consent  of  the 
Senate,  and  divide  them  into  four  classes,  with  terms  of  ser- 
vice of  four  years'  duration,  so  that  one-fourth  will  go  out  of 
office  annually.  Restore  the  disbursement  of  the  appropria- 
tion to  the  Treasury  of  the  United  States,  and  require  that 
all  funds  belonging  to  the  institution,  from  whatever  source 
derived,  be  deposited  in  the  National  Treasury.  Destroy 
the  boarding-house  feature  of  the  institution  and  forbid  the 


180  ESSAYS  AND  ADDRESSES. 

paymeut  of  salaries  to  any  medical  officer.  It  is  idle  to  rely 
upon  investigating  conimittees.  Daring  the  last  Congress 
the  House  of  Representatives  passed  a  resolution  directing 
the  committee  on  the  District  of  Columbia  to  investigate  this 
institution,  but  no  amount  of  dragooning  could  force  the 
chairman  to  commence  the  investigation.  Committees  can 
be  packed,  and  individual  members  too  often  prove  too  weak 
to  resist  the  blandishments  of  the  corrupt  rings  which  infest 
the  Capitol.  The  directory,  with  '^  O.  E.  Babcock,  Presi- 
dent," is  a  powerful  combination — bold,  imperious,  and 
defiant — and  will  not  fail  to  seek  the  destruction  of  any  man 
who  may  uplift  his  hand  against  their  wrongs  and  usurpa- 
tions. Then  to  the  defence  of  right  and  condemnation  of 
wrong  let  every  medical  man  throughout  this  land  lend  his 
aid.     "  Meue,  mene,  tekel,  upharsin  !  " 


WASHINGTON  MALARIA  AND  THE  "CATCHING 
OF  COLD." 

1882. 

Malaria  and  the  catching  of  cold  are  undoubted  factors 
in  the  causation  of  disease,  and  the  morbid  manifestations 
from  both  causes  are  frequently  so  much  alike  that  differen- 
tiation of  cause  is  not  always  easily  made.  Physicians  as 
well  as  laymen  constantly  mistake  the  effects  of  one  for  those 
of  the  other,  and  the  ills  that  afflict  us  are  sometimes  at- 
tributed to  the  unavoidable  and  baneful  influences  of  atmos- 
pheric contamination  when,  in  fact,  they  are  caused  by  the 
"  catching  of  cold."  In  the  common  language  of  this  locality, 
the  prevalent  ailments  are  called  malarial  and  believed  to  be 
the  necessary  result  of  even  a  temporary  sojourn  in  an  atmos- 
phere erroneously  supposed  to  be  always  charged  with  noxious 
exhalations  from  the  marshes  of  the  Potomac  and  Anacostia 
Rivers. 


ESSA  YS  A  SI)  Mihi; HSSES.  \  ^ ] 

No  ono  ran  deny  that  tlu;  cxtcin.sivc  livcr-liats  alon^  tlio 
eastern  and  s()(itli(!rn  honndaries,  tlie  sltifririHli  Htrcani  forming; 
the  western  border  (tf  the  eily,  and  the  Chesapeake;  and  Ohio 
Canal  whieli  ])enetrate.s  the  western  section,  nntil  hitely  known 
as  Georgetown,  which  is  always  laden  witli  debris  washed  by 
the  storm-water  from  the  streets,  and  the  filthy  products  of 
slack-water  navigation,  present  all  the  conditions  necessary 
to  the  development  of  miasmata.  Nor  will  anyone  excuse 
the  neglect  which  has  not  only  tolerated  these  long-standing 
nuisances,  but  permitted  them  to  increase  to  such  an  extent 
as  to  become  a  disgrace  to  the  National  Capital  and  the  cause 
of  many  forms  of  disease.  Nevertheless,  the  prevalence  and 
certaility  of  the  miasmatic  influence  do  not  afford  a  sufficient 
explanation  of  the  numerous  cases  of  sickness  and  indefinable 
ailments  which  habit  and  fashion  ascribe  to  malaria. 

While,  therefore,  admitting  the  existence  of  conditions 
necessary  to  the  production  of  malarial  diseases,  and  con- 
demning the  inexcusable  delay  in  abating  these  nuisances, 
my  observation  and  clinical  opportunities  induce  me  to  doubt 
that  malarious  contamination  of  the  atmosphere  is  the  exclu- 
sive cause  of  certain  irregular  forms  of  disease  which  prevail 
in  this  city,  especially  during  the  autumn  and  winter  seasons. 

As  yet,  malaria  has  not  been  isolated  as  a  defined  element 
or  quantity  recognizable  either  by  chemical  reactions  or 
microscopic  characters.  It  is  true  that  Ivlebs  and  Tommasi- 
Crudeli  have  announced  the  discovery  of  a  bacillus  malarice  ; 
but  the  more  recent  experimental  investigations  of  Sternberg 
relating  to  the  cause  of  malarial  fevers  fail  to  establish  the 
active  agency  of  these  organisms  in  the  causation  of  them  in 
man,  though  many  circumstances  '^  favor  the  hypothesis  that 
the  etiology  of  these  fevers  is  connected  either  directly  or 
indirectly  with  the  presence  of  these  organisms  or  their  germs 
in  the  air  and  water  of  malarial  localities."  Notwithstanding 
this  want  of  positive  knowledge  in  regard  to  its  true  nature, 
numerous  well-known  facts  and  circumstances  have  estab- 
lished a  belief  that  a  poison  is  generated  from  decomposing 


182  ESSAYS  A^W  ADDRESSES. 

vegetable  matter  under  the  combined  influence  of  heat  and 
moisture^  which,  when  introduced  into  the  system,  either 
through  the  respiratory  organs  or  alimentary  tract,  will  pro- 
duce certain  forms  of  disease,  which  vary  in  intensity,  form, 
and  type  according  to  the  virulence  of  the  poison,  tempera- 
ture, amount  absorbed,  and  individual  susceptibility.  For 
the  present  discussion  this  definition  of  malaria  is  sufficient, 
and  excludes  all  other  deleterious  emanations  and  morbid 
agencies,  either  chemical,  gaseous,  or  parasitic. 

The  development  of  this  poison  is  favored  by  marshes, 
more  especially  when  containing  mixed  salt  and  fresh  water 
and  resting  on  a  substratum  of  limestone,  clay,  or  mud ;  by 
swampy,  und rained,  and  delta  lands ;  extensive  excavations  ; 
newly  turned  soils ;  rains  after  long-continued  drought  and 
consequent  low  water-level ;  careless  culture  of  soil ;  neglect 
of  cultivation  where  vegetation  is  luxuriant  and  is  permitted 
to  decay  on  the  surface ;  and  in  fact  by  the  requisite  com- 
bination, wherever  present,  of  the  essential  elements — high 
temperature,  moisture,  and  decomposing  vegetable  matter. 
Nor  can  it  be  doubted  that  it  may  be  diffused  in  the  atmos- 
phere and  transported  by  winds  and  watercourses  to  non- 
malarious  localities. 

The  circumstances  which  hinder  or  prevent  the  generation 
of  miasmata  are  high  latitudes,  high  elevations,  drainage, 
sunlight,  sandy  or  porous  soil,  and  cold ;  of  these,  cold  is  the 
most  powerful.  The  first  fall  of  the  temperature  below  the 
freezing-point  in  any  malarious  region  arrests  the  pr  cess  of 
development,  and  it  does  not  recommence  until  the  tempera- 
ture again  ranges  continuously  during  the  day  and  night 
above  58°  F.  Malarial  diseases  are  rare  beyond  the  sixty- 
third  degree  of  north  latitude  and  the  fifty-seventh  degree  of 
south  latitude.  The  nearer  the  equator  from  either  of  these 
lines  the  diseases  increase  in  frequency  and  intensity.  These 
limits  are,  however,  greatly  affected  by  the  duration  and  high 
average  of  summer  heat  Hirsch  lias  shown  that  the  average 
summer  heat  is  a  more  potential  influence  than  the  average 


/<:ssAYS  AND  Annni'jss/'js.  is.'i 

annual  t(!in|)(;ral,iir<!  JIi<^li  clcjvatioii  ))r(!.s(;nts  many  f;urif)US 
exceptionn,  probably  dcipcndiii^;  iij)()ri  geological  ffjrmations. 
Strata  of  soil  or  other  impermeable  geological  formations 
whioh  obstruct  or  j)revent  the  percolation  of  the  water  anrl 
retain  it  in  a  loose  surface-soil  or  in  cleej)er  layers  containing 
decomposing  vegetable  matter  are  frequently  the  cause  in 
many  malarious  localities.  In  such  regions  subsoil-drainage 
is  the  only  e(Tcctual  ])revcntive.  Sewers,  with  water-tight 
conduits  (as  they  ought  to  be  in  all  cities)  for  the  conveyance 
of  the  filth  and  storm-water,  cannot  accomplish  much  toward 
soil-drainage.  Tlie  cleavage  of  impermeable  strata  caused  by 
the  necessary  evacuations  may  facilitate  percolation  to  a  lim- 
ited extent,  but  is  altogether  insufficient  in  those  cities  stand- 
ing upon  soils  where  the  conditions  exist  which  render  soil- 
drainage  necessary. 

Miasmata  are  generated  more  rapidly  and  the  poison  is 
more  intense  during  night  than  during  sunlight,  and  a  humid 
atmosphere  and  rapid  evaporation  favor  its  production.  Hence 
the  salutary  influence  of  solar  light  is  modified  by  the  moist- 
nre  of  the  air,  the  rapidity  of  evaporation,  and  the  total  move- 
ment of  the  wind. 

An  analysis  of  the  conditions  and  circumstances  favorable 
and  unfav^orable  to  the  generation  of  miasmata  and  their  ap- 
plication to  this  locality  lead  to  the  conclusion  that  this  city 
presents  other  conditions  favorable  to  the  production  of  mias- 
mata in  addition  to  the  constantly  increasing  river-flats,  which 
are  so  universall}'^  condemned  as  the  chief  cause  of  malarial 
diseases.  The  city  is  located  in  a  basin  surrounded  by  a  range 
of  hills,  broken  on  the  east  by  the  Anacostia  River  and  its 
damp  and  swampy  lowlands;  on  the  north  by  Rock  Creek; 
and  on  the  west  by  the  Potomac  River,  which  washes  the 
entire  southern  boundary  of  both  cities  and  emerges  from  the 
basin,  after  uniting  with  the  Anacostia  at  a  sharp  bend  toward 
the  south,  below  the  flats,  leaving  along  its  southern  shore  an 
extensive  area  of  swampy  land,  subject  to  occasional  overflow 
and    usually,    during    the    summer,   covered    with  luxuriant 


184  ESSAYS  AND  ADDRESSES. 

vegetation  under  careless  cultivation,  over  which  the  pre- 
vailing southern  winds  of  that  season  must  come.  Under 
the  centre  of  the  city  flows  Goose  Creek  to  its  sewer  connec- 
tion. This  was  formerly  a  tributary  of  the  Tiber,  but  is  now 
the  common  sewer  of  a  densely  populated  portion  of  the  city, 
quite  equal  iu  territorial  area  to  the  original  drainage-limits 
of  this  stream.  Further  eastward  is  the  Tiber,  a  large  and 
sluggish  stream,  which  has  its  source  in  the  hills  above  the 
city.  It  was  the  main  and  natural  drainage-stream  of  a  large 
part  of  the  northern  and  northeastern  sections  of  the  city,  into 
which  several  lesser  streams,  lying  wholly  within  the  city- 
limits,  empty.  After  passing  the  west  front  of  the  Capitol 
park  it  originally  turned  abruptly  westward  and  emptied  into 
the  Potomac  south  and  west  of  the  Executive  Mansion.  This 
part  of  the  stream  was  diverted  by  the  construction  of  the 
Washington  City  Canal,  which  occupied  its  bed  from  its 
mouth  to  the  bend  before  referred  to,  and  thence  extended 
in  a  southeasterly  direction  along  the  valley  at  the  base 
of  the  elevated  plateau  upon  which  the  Capitol  stands. 
The  canal  is  now  replaced  by  the  B  Street  sewer,  running 
westward  to  the  Potomac  from  West  Sixth  Street ;  thence 
eastward  by  another  sewer  connecting  at  the  Botanical  Gar- 
den with  the  Tiber  Creek  sewer,  which  from  this  point  fol- 
lows the  course  of  the  eastern  division  of  the  canal  to  its 
intersection  with  the  valley  of  James  Creek.  Below  and 
southeast  of  the  latter  point  the  canal  remains  open,  and  is 
the  common  receptacle  of  the  sewage,  soil-drainage,  storm- 
water,  and  filth  of  that  neglected  section.  It  was  built  for 
commercial  and  drainage  purposes.  By  its  construction  (the 
earth  from  the  excavation  having  been  used  for  filling)  the 
marshes  and  lowlands  which  occupied  for  the  most  part  the 
area  lying  south  of  Pennsylvania  Avenue,  and  north  of  the 
reservation  known  as  the  Mall,  have  been  reclaimed  and  are 
now  appropriated  in  part  for  parks,  but  mainly  for  commer- 
cial and  industrial  purposes.  Throughout  the  extent  of  this 
reclaimed   territory   the   soil-drainage   is    inadequate.      The 


Ef^SA  YS  A  Nl)  A  DDREHSKH.  ]  85 

ccllurH  oi."  th(;  biiildiii^H  arc  darii])  and  coiiHtaiiLly  Hubjcct  to 
overflow  by  back-water  from  the  Potomao  and  from  heavy 
rains.  During  the  spring  of  1881  Pennsylvania  Avenue  from 
the  Caj)itol  grounds  as  far  west  as  Tenth  .Street  was  inun- 
dated ;  and  in  some  places  the  water  reached  several  feet  in 
depth,  and  passengers  were  conveyed  to  and  from  the  iialti- 
more  and  Potomac  depot  in  boats. 

Previously  to  the  construction  of  the  storm-water  conduit 
along  New  York  Avenue  from  West  Seventh  Street,  down 
West  Fifteenth  Street,  and  thence  through  the  grounds  south 
of  the  President's  house  to  its  outlet  into  the  Potomac  at  the 
foot  of  West  Seventeenth  Street,  the  B  Street  sewer  was  the 
carrier  of  all  the  sewage  and  fall-water  from  the  central  and 
most  populous  part  of  the  city  included  within  the  lines  of 
the  West  Seventh  and  Seventeenth  Streets  north  to  Vermont 
and  Rhode  Island  Avenues.  The  construction  of  this  conduit 
was  a  very  important  improvement,  because  of  the  incapacity 
of  the  B  Street  sewer,  and  the  contemplated  diversion  to  the 
Boundary  intercepting  sewer  of  the  rainfall  and  sewage  of 
the  area  between  West  Fourteenth,  North  N,  and  Boundary 
Streets,  will  be  an  additional  relief  to  the  sewer-mains  empty- 
ing into  the  Potomac.  In  the  B  Street  area  the  carriage- 
ways are,  for  the  most  part,  paved  with  concrete  and  asphalt. 
Through  it  runs  Goose  Creek  sewer.  Its  subsoil-drainage  is 
limited  to  the  percolation  along  the  sewer  excavations  and 
distribution. 

The  Tiber  to  the  northern  boundary  of  the  city  has  been 
arched  and  converted  into  a  sewer,  aud  now  finds  its  exit  into 
the  Auacostia  through  the  recently  built  open  sewer  along 
the  bed  of  James  Creek.  The  area  of  the  Tiber  valley  system 
of  storm-water  drainage  and  sewage  is  very  large,  extending 
westward  to  the  east  line  of  the  B  Street  area,  north  and 
northeastward  along  the  Boundary  Street  sewer  to  its  inter- 
section of  IMaryland  Avenue,  aud  is  bounded  on  the  east  aud 
south  by  Maryland  Avenue,  East  Sixth  Street,  and  North 
Carolina  Avenue  to  its  southern  terminus  at  the  crossing  of 


186  ESSAYS  AXD  ADDRESSES. 

JN^ew  Jersey  Avenue  and  E  Street  south.  The  sewage,  rain- 
fall,  and  waters  of  the  numerous  springs  formerly  scattered 
throughout  this  territory  and  the  tributaries  of  the  Tiber 
south  of  the  Boundary  intersecting  sewer  are  carried  by  the 
same  conduits.  The  valley  of  the  Tiber  and  its  tributaries 
originally  extended  far  into  the  eastern  and  northern  sec- 
tions, and  even  beyond  the  northern  limits  of  the  city.  It 
constituted  the  largest  single  drainage-area  in  the  basin. 
Within  its  borders  were  several  marshes  covering  large  areas, 
notably  the  localities  formerly  known  as  '^  Swampoodle,"  the 
vicinity  of  the  Public  Printing  Office  and  St.  Aloysius' 
Church,  and  the  larger  part  of  the  ^'slashes."  The  latter 
was  a  long  and  narrow  strip  of  boggy  and  swampy  land 
stretching  eastward  and  westward  along  the  base  of  the  hills 
on  the  northern  frontier,  insufficiently  drained  by  two  small 
streams,  one  now  known  as  Slash  Run  sewer,  emptying  into 
Eock  Creek,  below  the  P  Street  bridge,  the  other  a  branch 
of  the  Tiber. 

It  thus  appears  that  the  surface  of  that  portion  of  the  floor 
of  the  basin  upon  which  Washington  now  stands  was  origin- 
ally traversed  by  extensive  valleys,  and  that  the  central  and 
most  densely  populated  part,  lyiug  between  the  Capitol  and 
Rock  Creek,  was,  in  fact,  an  island,  surrounded  by  streams 
of  running  water,  marshes,  and  boggy  lowlands.  Its  sur- 
face was  uneven  and  irregular,  broken  by  numerous  eleva- 
tions, depressions,  and  natural  drainage-courses,  either  sur- 
face or  subsoil,  which  have  been  mostly  obliterated. 

The  foregoing  description  of  the  soil,  marshes,  running 
streams,  and  springs,  which  were  unusually  numerous  in 
such  a  small  territory  as  that  included  within  the  city's 
limits,  has  beeu  introduced  to  show  that  the  natural  drainage 
of  the  subsoil  was  insufficient,  and  that  consequently  there 
were  formed  large  tracts  of  marshes  and  swampy  and  boggy 
lands.  The  conversion  of  the  streams  into  sewers,  with 
water-tight  conduits,  has  diminished  their  subsoil-drainage 
capacity,   and   in  fact  has  limited  the   soil-drainage  to  the 


J<:SSA  rS  A  i\l)  A  DUUESSICS.  1 87 

sonrcos  of  tlie  HtrcjaiiiH  uiid  kik'.H  additjonal  pcirolation  of 
water  as  may  tako  plac'o  in  ilic  (ixfavatioiis  lliroii^li  llif;  earth 
rammed  along  the  walls  of  \\\v.  coiidiiits.  How  far  tliis  dis- 
turbance of  natural  draina<j;('  made;  ncf-essary  by  the  seweraj^e 
system  may  compensate  for  the  innumerable  subsoil  pores  and 
crevices  which  must  have  discharged  on  either  side  into  the 
open  watercourses  cannot  be  ascertained.  It  cannot,  how- 
ever, be  comjilete.  It  is  true  the  conveyance  of  the  storm- 
water  from  the  surface  by  grading,  paving,  and  sewerage,  the 
diminution  of  the  open  and  exposed  area  by  buildings,  pave- 
ment of  streets  and  sidewalks,  and  especially  by  the  imperme- 
able pavements,  have  greatly  lessened  soil-saturation  from  fall- 
water.  The  extent  of  evaporatiug-surface  has  also  been  greatly 
diminished.  Whether  these  artificial  interferences  have  con- 
tributed to  the  sanitary  improvement  of  the  underl3'ing  earth 
is  an  unsettled  problem.  A  porous  soil  forming  the  greater 
portion  of  the  floor  of  a  great  basin,  the  surface  of  which,  for 
the  most  part,  is  but  slightly  elevated  above  the  water-level  of 
the  great  streams  lying  along  three-fourths  of  its  circumfer- 
ence, and  at  the  foot  of  a  range  of  high  hills  on  the  other  fourth, 
must  be  subject  to  constant  capillary  filtration,  even  to  satu- 
ration, at  a  depth  not  far  above  the  water-level  in  the  con- 
tiguous and  surrounding  rivers.  This  capillary  circulation 
is  increased  by  high  temperature,  to  which  the  extensive  sur- 
face of  impermeable  asphalt  and  concrete  pavements  is  prob- 
ably a  very  considerable  contributor,  especially  during  the 
season  when  the  solar  heat  ranges  above  an  endurable  tem- 
perature. Thus,  notwithstanding  the  diminution  of  storm- 
water  percolation  and  superficial  area  of  soil-saturation,  con- 
ditions are  present,  during  the  greater  part  of  the  year,  which 
promote  the  capillary  circulation  throughout  the  porous  strata. 
The  exposed  evaporating-surface  being  lessened  by  the  means 
before  referred  to,  the  exhalations  must  find  their  escape 
mainly  through  the  uncovered  parks  and  spaces,  permeable 
pavements,  and  cellars,  basements,  and  foundations  of  houses 
not  protected  by  concreted  flooi*s  and  cemented  walls.     The 


188  ESSAYS  AND  ADDRESSES. 

evidence  of  this  constant  filtration  may  be  noted  at  any  time 
(even  though  no  rain  has  fallen  for  days  or  weeks)  by  com- 
paring the  relative  dryness  of  the  brick  sidewalks  on  the 
north  and  south  sides  of  streets  running  east  and  west  (most 
marked  at  night),  and  in  many  localities  the  same  condition 
is  shown  by  the  walls  of  buildings  for  several  feet  above  the 
level  of  the  sidewalk.  It  is  more  observable  along  the  streets 
where  the  carriageways  are  paved  with  impermeable  mate- 
rial. In  the  cellars,  basements,  and  ground  stories  of  houses 
unprotected  by  impermeable  walls  and  floors  the  evidences 
are  even  more  apparent.  ]  will  not  assert  that  these  emana- 
tions are  laden  with  the  poison  of  miasm,  but  the  supposition 
of  its  presence  is  not  without  some  show  of  reason,  inasmuch 
as  heat  and  moisture  are  certainly,  and  decomposing  vegetable 
matter  presumably,  present,  more  especially  in  those  localities 
where  the  surfaces  have  been  changed  by  considerable  tilling. 
The  water  which  oozes  through  the  system  of  capillary  irriga- 
tion may  be  impregnated,  as  it  is  mainly  derived  from  streams 
that  have  coursed  through  many  miles  of  malarious  territory. 
Even  if  the  exhalation  is  free  from  miasmatic  poison,  the  in- 
creased humidity  of  the  air  surrounding  and  permeating  the 
walls  of  dwellings  and  diffused  through  the  apartments  of  the 
occupants  is  unsanitary,  and  becomes  an  important  and  preva- 
lent factor  in  the  causation  of  the  morbid  processes  incident 
to  the  catching  of  cold,  which  will  be  considered  further  on. 

It  must  not  be  forgotten  also  that  our  summers  are  long 
and  hot.  The  temperature  throughout  the  months  of  June, 
July,  August,  and  September — some  years  a  month  earlier 
and  later — runs  continuously  during  day  and  night  above 
the  elevation  necessary  for  the  generation  of  miasmata,  and 
also  that  during  the  months  of  greatest  heat  the  total  move- 
ment of  the  wind  is  less  than  during  other  months  of  the 
year — circumstances  favorable  to  a  rapid  production  and  con- 
centration of  miasmata. 

The  section  of  the  city  west  of  Rock  Creek,  formerly  known 
as  Georgetown,  presents  conditions  not  less  favorable  to  the 


ESSA  YS  A  Nl>  A  DDRESSES.  ]  89 

generation  ol'  miusm.  It  is  located  iijxhi  a  sifjpe  rapidly 
ascending  from  the  water-level  of  the  Potomac  to  an  eleva- 
tion of  several  hnndrcd  feet  above  the  Hcu-level  ;  ih  sur- 
ronnded  on  three-fourths  of  its  circumference  by  water,  with 
Analostan  Island  and  its  contiguous  marshes  in  front;  is 
penetrated  by  the  Chesapeake  and  Ohio  Canal;  its  sewerage 
is  insiinicient;  it  is  without  subsoil-drainage,  and  is  closely 
and  (!onipa(!tly  built,  and  with  streets  narrow  and  insufficient 
for  ventilation  and  evaporation.  The  houses  are  mostly 
built  of  brick  with  unprotected  foundations  and  cellars,  and 
upon  a  surface  with  underlying  impermeable  strata.  High 
above  its  most  populous  portion  are  two  large  cemeteries,  in 
which  the  number  of  interments  is  daily  increasing. 

If  the  result  of  investigation  recently  promulgated  by  Pas- 
teur in  his  address  before  the  London  International  Medical 
Congress  should  be  confirmed,  that  the  germs  of  the  disease 
do  not  die  with  the  death  and  burial  of  the  victim,  but  retain 
vitality  and  the  power  of  reproduction  for  years,  the  question 
of  the  removal  of  cemeteries  beyond  the  limits  and  suburbs 
of  cities  will  soon  agitate  the  popular  mind  of  large  munici- 
palities. I  would  not  utter  one  word  which  could  lessen  the 
love  and  respect  so  universally  shown  to  the  dead  by  the  pro- 
tection aud  embellishment  of  burial-places ;  but  we  live  for 
the  living  and  not  for  the  perishable  bodies  of  the  dead,  from 
which  poisonous  emanations  may  be  constantly  permeating  the 
earth  and  be  diiFused  in  the  air  we  breathe  and  the  water  we 
drink.  Cremation  is  repulsive  to  our  devotional  aud  emo- 
tional sensibilities,  but  may  yet  become  a  necessary  sanitary 
reform.  Life  aud  health  are  the  sum  of  all  values  to  the 
human  being. 

For  cleanliness  of  its  streets  and  general  surface  this  city  is 
not  excelled,  if  equalled,  by  any  other  known  to  the  writer. 
The  admirable  system  of  street-sweeping,  the  smooth  pave- 
ments, undulating  surface,  prohibition  of  deposits  of  refuse 
in  the  streets,  and  acquiescence  of  the  people  in  every  effort 
to   improve   its    sanitary   condition,    contribute   to    prevent 


190  ESSAYS  AND  ADDRESSES. 

collections  of  dirt,  filth,  and  foul  and  extraneous  matter  in 
the  streets.  The  garbage  department  is  probably  as  well  exe- 
cuted, and  the  alleys  are  kept  in  better  order  than  is  usual 
in  large  cities.  There  are  comparatively  few  localities  where 
masses  of  squalid  and  vicious  people  are  huddled  in  filthy, 
insufficient,  and  unfit  habitations.  There  is  comparatively 
little  poverty,  want,  and  suffering,  notwithstanding  the  large 
proportion  of  indigent  and  idle  negroes.  The  climate  is 
temperate  and  salubrious.  The  plan  of  the  city,  with  its 
"wide  streets  and  avenues,  and  its  numerous  parks  and  open 
spaces,  affords  great  protection  against  the  extension  and 
virulence  of  contagious  and  infectious  diseases. 

The  escape  of  sewer-gas  into  private  dwellings  is  one  of 
the  most  frequent  alleged  causes  of  disease.  No  intelligent 
physician  will  deny  its  deleterious  influence.  It  is  a  fact, 
however,  in  this  city  that  the  greatest  number  of  deaths  from 
zymotic  and  pulmonary  diseases  (see  maps  showing  distribu- 
tion of  deaths  in  the  annual  reports  of  the  health  officer  for 
the  years  1879  and  1880)  occur  in  those  parts  corresponding 
with  the  localities  of  former  soil-saturation  and  now  deficient 
soil-drainage,  as,  for  instance,  the  extensive  area  originally 
traversed  by  the  valley  of  the  Tiber  and  its  branches,  the 
Slashes,  Slash  Run  and  its  contiguous  lowlands,  and  that 
part  known  as  South  Washington.  In  the  latter  district  the 
drainage  is  surface  and  bad,  "  many  of  the  gutters  do  not 
carry  away  the  storm,  slop,  and  waste  water,  and  it  is  left  to 
evaporate  or  find  its  way  into  the  soil." 

Even  if  sewer-gas  was  not  an  active  agency  in  the  pro- 
duction of  disease,  it  is  a  nuisance  that  ought  not  to  be  toler- 
ated in  any  habitable  dwelling.  In  some  houses  the  odor 
from  foul  and  improperly  cleansed  fixed  washstands,  water- 
closets,  privies,  and  insufficiently  ventilated  rooms  is  mistaken 
for  sewer-gas  ;  nevertheless  in  many  others  the  air  is  rendered 
impure  and  unhealthy  by  its  admixture  with  sewer-emana- 
tions. This  is  most  usually  due  to  the  imperfect  plumbing 
and  house-drainage,  and  not  to   defect  in  the  system  and 


ESS  A  YH  AND  ADDRESSES.  191 

construction  of  tlie  Hew(!r-iiiainH.  Tlu!  rainfall  and  Hewa^e  arc 
carried  od'  in  tin;  same  oondiiits,  "  the  pririfiijial  main  Hfjwcrs 
(s(!(!  I,(i(!iit('nant  IIoxic'H  rc[)()rt,  1880),  followin<^  tli<;  lino  of 
natural  (Irainai^(!/'  discliarj^o  at,  intervals  aioiifr  tho  water- 
front, tliuH  H(!curinr^  diffusion  and  dilution  of  tlio  sewage. 
The  combinations  of  the  systc^ras  of  sewai^c;  and  storm-water 
drainage,  and  the  transferrenee  of  the  runninj^  streams  into 
the  same  conduits,  promote  constant  agitation  and  admixture 
with  pure  water  and  a  more  rapid  conveyance  and  greater 
aeration  of  the  sewage,  thereby  diminishing  the  generation 
and  promoting  the  innocuousness  of  the  gases.  Lieutenant 
Hoxie  says  "  nearly  all  the  gas  not  due  to  defective  plumb- 
ing in  houses  is  generated  in  the  tidal  sections  of  "  the  prin- 
cipal main  sewers.  He  believes  "  the  motion  of  the  tides 
driving  back  these  gases  at  the  flood  "  is  advantageous,  inas- 
much as  it  induces  motion  and  promotes  their  withdrawal  and 
replacement  by  fresh  air.  The  oval  ''shape  of  the  sewers 
concentrates  (Hoxie)  the  dry-weather  flow  in  the  invert,  and 
the  large  air-space  above  is  favorable  to  a  prompt  oxidation 
of  such  gases  as  may  form  during  the  short  time  occupied  in 
flowing  to  tide-water."  Ventilation  is  effected  by  grated 
manholes  at  short  intervals.  The  chief  defect  of  the  system 
is,  perhaps,  the  deficient  fall  of  the  sewer-mains.  This  is 
partially,  if  not  wholly,  compensated  for  by  the  combination 
of  the  two  systems.  It  is  believed  that  if  the  engineer  de- 
partment could  be  clothed  with  authority  to  adopt,  free  from 
the  trammels  of  individual  and  speculative  interests,  and  be 
supplied  with  funds  sufficient  to  execute  a  plan  of  improve- 
ment and  extension,  the  sewerage  of  this  city  would  be  as 
complete  as  possible,  and  far  in  advance  of  that  of  most  large 
cities.  Even  in  its  present  unfinished  condition  it  must  be 
admitted  that  the  constantly  alleged  danger  from  escape  of 
the  gases  into  private  dwellings  is  overstated,  except  so  far 
as  it  is  due  to  faulty  plumbing  and  house-drainage — defects 
not  attributable  to  the  general  plan  or  to  the  engineer  depart- 
ment, but  directly  chargeable  to  the  negligence  of  the  owners 


192  ESS  A  YS  AND  ADDRESSES. 

and  builders  of  the  houses.  This  evil  can  ouly  be  corrected 
by  the  vigilance  and  supervision  of  the  health  department, 
which  has  several  times  invoked  the  necessary  authority,  but 
as  yet  without  securing  the  assent  of  Congress.  Such  emana- 
tions, though  productive  of  disease,  do  not  often  cause  mala- 
rial diseases. 

If  not  demonstrated,  it  is  very  generally  believed,  that  the 
soil  of  malarious  regions  contains  the  malarious  poison  in 
great  quantity,  eveu  during  the  season  when  malarial  dis- 
eases do  not  affect  human  beings.  It  is  also  believed,  and 
medical  topography  supplies  abundant  affirmative  testimony, 
that  moist  subsoils,  with  surfaces  exposed  to  high  tempera- 
tures and  rapid  evaporation,  present  all  the  conditions  neces- 
sary for  the  generation  of  this  poison.  In  such  places  the 
ground-air  may  become  contaminated  and  the  poison  may  be 
gathered  in  the  strata  of  air  near  or  on  the  surface.  Nature's 
method  of  drainage  is  by  streams  and  rivers.  Ground-water 
seeks  the  level  of  the  drainage-streams.  Rivers  receive  the 
waters  of  their  tributaries,  the  tributaries  of  the  lesser  streams, 
each  of  which  is  the  confluent  of  smaller  branches,  until  we 
reach  the  rills  and  rivulets  which  are  formed  by  the  storm- 
water  which  penetrates  the  earth  and  percolates  through  the 
interstices  and  pore-canals.  The  rainfall  flows  from  the  sur- 
face toward  the  sea.  The  large  and  smaller  streams  drain 
larger  and  smaller  areas ;  these  areas  are  interspersed,  more 
or  less,  with  uplands  and  lowlands,  hills  and  valleys,  moun- 
tains and  plains,  prairies  and  forests,  and  arid  and  swampy 
lands.  Every  such  tract,  however  small,  has  its  natural 
drainage-course ;  it  may  be  a  mere  depression  of  the  surface, 
a  running  rill,  or  a  majestic  river.  As  the  larger  are  made 
of  the  waters  of  the  smaller  streams  flowing  from  sources  of 
varying  elevation,  even  up  to  the  plane  of  the  pore-canal,  so 
must  the  height  of  soil-saturation  of  the  different  parts  of  a 
given  area  vary  with  the  water-level  of  its  drainage-course ; 
but  it  can  never  sink  below  the  plane  of  the  nearest  running 
and  never-failing  stream,  and  will  always  be  affected  by  the 


ESS  A  YS  A  ND  A  DDRI'JSSJ'JS.  1  «j:> 

frequeiKiy  aiul  anioiint  of  |)i'c(!ij)i(uti()ii,  ilic  natiiiv;  (»f  tlio  Htrata 
of  the  oartli,  and  IIk;  slope  of  the  watemhed.  'J'he  i*otomac 
and  Anacostia  Rivers,  which  wash  the  shorwi  of  this  great 
basin,  fix  the  plane  below  whieh  soil-saturation  can  never 
sink.  Thiri,  in  many  plaees,  is  but  a  few  feet  below  the  nat- 
ural surface;  bnt,  because  of  the  nature  of  the  geological 
strata  and  other  peciuliaritles  of  the  situation,  there  are  nume- 
rous localities  wlien;  the  point  of  soil-siituration  is  far  above 
the  plane  thus  established  and  so  near  the  surface  as  to  be 
reached  by  the  excavations  necessary  for  buildin^i-purposes. 
The  preceding  description  of  the  original  topography  points 
out  such  parts,  marked  by  depressions,  marshes,  swamps, 
springs,  and  surface-streams ;  the  maps  of  the  health  dej>art- 
ment,  showing  the  distribution  of  deaths  from  certain  dis- 
eases, prove  the  unhygienic  condition  of  such  situations  and 
their  unfitness  for  purposes  of  habitation.  The  diminution 
of  the  superficial  area  of  storm-water  percolation  has  cer- 
tainly lessened  the  amount  of  ground-water,  and  the  construc- 
tion of  water-tight  conduits  has  facilitated  the  conveyance  of 
the  surface-water  to  the  river-channels.  While  the  transfer 
of  the  drainage-streams  to  the  sewers  has  its  advantages,  it 
is,  nevertheless,  manifest  that  such  conduits  are  not  subsoil- 
drains,  and  that  the  modes  of  escape  of  the  ground-water, 
especially  in  some  parts,  are  wholly  inadequate  for  sanitary 
purposes.  The  filling  of  depressed  parts,  and  the  attempt  of 
the  late  board  of  public  works  to  reduce  the  surface  of  the 
basin  to  a  common  level,  have  obliterated  unsightly  ponds 
and  marshy  lowlands,  but  have  not  lowered  the  plane  of  the 
soil-saturation.  In  fact,  in  many  places  the  distance  between 
the  surface  and  this  plane  has  been  diminished,  as  may  be 
seen  after  seasons  of  wet  M^eather,  when  whole  squares  of  un- 
occupied ground  are  submerged  and  adjacent  cellars,  base- 
ments, and  foundations  are  inundated  by  soil-water.  This  is 
more  constantly  observed  in  the  localities  of  former  marshes 
and  places  insufficiently  drained  previous  to  any  artificial  dis- 
turbance of  the  natural  topography,  and  where  the  natural 

13 


194  ESSAYS  AND  ADDRESSES. 

drainage  has  been  transferred  to  the  sewer-mains,  and  such 
percolation  as  may  take  place  along  the  excavations.  To 
correct  these  natural  unsanitary  conditions,  and  to  remove 
the  obstructions  interposed  both  by  nature  and  art,  are  matters 
of  grave  interest  to  the  permanent  population  and  to  the 
national  government.  As  the  general  surface  of  the  floor  of 
the  basin  is  but  little  above  the  elevation  of  the  tidal  wave, 
it  is  not  probable  that  engineering  skill  will  ever  successfully 
obviate  all  of  the  obstacles  presented ;  but  there  can  be  no 
doubt  of  the  value  and  practicability  of  a  system  of  subsoil- 
drainage  which  will  lower  the  subsoil-saturation  throughout 
those  parts  of  the  territorial  area  where  it  is  made  necessary 
by  the  geological  structure  and  artificial  interference.  That 
such  a  system  will  contribute  greatly  to  the  mitigation  of  the 
natural  defects  and  promote  the  healthf alness  of  the  city  there 
can  be  no  doubt,  as  is  illustrated  in  the  improved  sanitary 
condition  of  certain  towns  and  cities  in  England,  where  the 
subsoil  has  been  effectively  drained.  As  shown  on  the  maps 
previously  referred  to,  and  demonstrated  by  Dr.  H.  I.  Bow- 
ditch,  of  Boston,  by  observations  made  throughout  the  State 
of  Massachusetts,  pulmonary  consumption  bears  a  positive 
and  constant  relation  to  soil-saturation.  The  same  fact  has 
been  shown  in  England  by  a  series  of  observations  made 
under  the  direction  of  Mr.  Simon,  by  Dr.  Buchanan;  and 
the  additional  fact,  also,  that  this  disease  had  decreased  in 
those  towns  after  the  drainage  of  the  subsoil,  most  markedly 
so  in  those  where  the  level  of  subsoil-saturation  was  most 
lowered.  Dr.  Mead,  the  medical  sanitary  inspector  of  this 
city,  makes  the  emphatic  statement  (report  of  health  officer 
for  1880)  that  in  certain  localities  in  this  city  where  better 
drainage  has  been  secured  a  marked  decrease  has  taken  place 
in  the  number  of  deaths  from  phthisis,  acute  respiratory  and 
diarrhoeal  diseases.  The  city  of  Detroit  was  built  upon  a 
low  and  wet  soil,  and  it  was  a  very  sickly  town ;  but  since 
the  improvement  in  the  drainage  it  has  become  one  of  the 
healthiest  cities  in  the  country.     Dr.  Elliot  has  shown  that 


ESSAYS  A.\ I)  AJ)/)IU-:SS/'JS.  ]()rj 

in  New  OrleuiiH,  in  vvliicli  city  tlicrc  is  conHtantly  present  tfie 
condition  of  cx(;cHsiv<;  Hoil-nioiHtnrc,  tlio  mortality  from  j)ul- 
raonary  consumption  for  the  years  1869  to  1870,  inclusive, 
nearly  doubled  that  of  cither  yellow  fever,  malarial  fever,  or 
diarrhfcal  diHeaseSj  and  that  th(!  excess  of  flcatlis  from  that 
disease  occurred  during  the  six  warmer  months  of  the  year. 

Ground-air*  is  perhaps  neither  a  less  potential  nor  a  less 
frequent  factor  than  ground-water  in  the  causation  of  disease. 
The  popular  belief  is  that  the  atmosphere  ends  where  the 
ground  begins;  but  the  fact  is  that  the  pores  of  the  earth, 
when  not  iilled  with  water,  are  filled  with  air.  The  quantity 
varies  according  to  the  nature  of  the  soil.  The  greater  its 
porosity  the  more  air  it  can  contain.  Rubble  soil,  gravel, 
or  sand  will  hold  about  35  per  cent,  of  its  mass  of  air.  The 
degree  of  humidity  of  a  soil  represents  the  amount  of  ground- 
water, and  soil-saturation  begins  at  the  lowest  limit  of  the  air. 
Ground-air  contains  a  larger  proportion  of  carbonic  acid  than 
either  the  atmosphere  or  the  ground-water,  and,  at  a  few  feet 
below  the  surface,  even  more  than  is  usually  found  in  badly 
ventilated  dwellings.  The  quantity  is  greater  duriug  winter 
than  summer,  and  increases  with  the  depth,  except  during 
the  months  of  June  and  July,  when  the  percentage  is  in- 
versed.  Pettenkoffer  concludes  from  his  investigations  that 
the  soil  is  the  source  of  this  gas,  and  is  yielded  by  it  to  the 
ground-water  and  ground-air,  most  freely  to  the  latter ;  and 
he  believes  that  it  finds  its  origin  in  organic  processes  taking 
place  in  the  soil.  Huxley,  Haeckel,  and  others  have  shown 
that  organic  life  exists  everywhere  in  every  porous  soil,  as 
well  as  at  the  bottom  of  the  sea.  The  more  porous  the  soil, 
the  greater  the  quantity  and  more  rapid  the  diffusion  of  air; 
the  more  active  the  processes  of  decay  and  putrefaction,  the 
greater  the  development  of  low  organisms  and  the  more  abun- 
dant underground  life.  The  ground  is  not  only  permeable, 
but  the  air  it  contains  is  in  constant  motion,  produced  by  the 

1  These  data  have  been  summarized  from  Pettenkoffer's  lecture  on  "  The  Relation 
of  the  Air  to  the  Soil  or  Ground-air." 


196  ESSAYS  AND  ADDRESSES. 

pressure"  of  the  atmosphere  and  wind  against  the  surface ;  by 
differences  of  temperature ;  by  any  and  every  cause  which  can 
produce  movement;  and  by  the  general  law  of  the  diffusion 
of  gases.  The  leakage  of  coal-gas  from  street-mains  has  fre- 
quently been  known  to  permeate  the  earth  beneath  the  street, 
penetrate  walls,  vaults,  and  foundations,  and  escape  into 
dwellings  at  considerable  distances  from  the  leak.  So,  also, 
has  the  poison  of  disease  been  transported  by  underground 
conveyance.  Whatever  impurities  and  pollutions  may  con- 
taminate the  ground-air  will  be  diffused  by  the  current  and 
constant  change  going  on.  It  may  be  impregnated  with 
noxious  emanations  generated  either  on  or  below  the  surface. 
All  forms  of  filth,  the  excreta  of  animals,  and  the  processes 
and  products  of  putrefaction  collected  upon  or  under  the  sur- 
face, or  deposited  in  vaults,  cesspools  or  pits,  constitute  foci 
from  which  deleterious  exhalations  are  disseminated  through- 
out the  ground.  In  cities  and  other  places  where  people  are 
massed  in  larp;e  numbers  in  circumscribed  areas  the  soil- 
water  and  ground-air  will  be,  to  a  great  degree,  unfitted  for 
the  purposes  of  human  life  by  such  poisonous,  and,  often- 
times, disease-bearing  effluvia.  They  are  more  detrimental 
to  life  when  received  into  the  system  through  the  ground-air 
than  when  conveyed  through  the  atmosphere,  because  more 
concentrated  and  mixed  with  larger  percentages  of  carbonic- 
acid  gas.  When  exhaled  into  the  free  atmosphere  they  are 
more  easily  diffused  and  diluted,  are  blown  away  by  the 
winds,  and,  probably,  more  speedily  oxidized  and  rendered 
inert.  But  how  can  the  ground-air  reach  us  ?  Currents  are 
created  by  differences  of  temperature,  and  will  be  in  the 
direction  of  the  higher.  It  should  then  constantly  oscillate 
up  and  down  toward  the  atmosphere  and  into  the  earth. 
Fortunately  for  human  life  it  does  this,  and  in  the  pro- 
cess the  earth  is  ventilated  and  the  deleterious  constituents 
of  the  ground-air  are  diffused  into  space.  But  this  move- 
ment and  change  of  air  between  the  atmosphere  and  the  earth 
is  only  partial,  and  is  influenced   by  many  conditions  and 


ESS  A  YS  A  NI)  A  DDIiKSSES.  \  U7 

circumstances,  sucli  as  the  cnrnsntH  and  force  of  the  wind; 
formation  of  the  soil ;  amonnt  and  frcqncncy  of  |)roci[)ita- 
tions ;  degree  of  Hoil-hntnidity  and  depth  of  soil-satnration. 
It  comes  to  us  wiien  least  expected,  and  when  least  resistancM? 
can  be  offered  to  its  influences.  It  comes  with  hifrli  percent- 
age of  carbonic-acid  gas,  with  relativ(!  high  iiumidity,  and, 
perhaps,  ladcned  witli  the  germs  of  disease.  It  comes  in  our 
dwellings,  in  our  sleeping-apartments,  during  the  hours  of 
rest  and  re[)ose,  and  is  most  a[)t  to  do  so  when  we  are  niost 
securely  protecting  ourselves  from  the  external  atmosphere, 
either  because  we  f(}ar  its  injurious  contaminations  or  its  chill- 
ing influences.  It  comes  under  the  surface,  passes  through 
the  air,  and  the  permeable  walls,  foundations,  and  floors  of 
our  houses,  and  poisons  the  air  we  breathe.  Every  house 
unprotected  by  fouudations  and  walls  impermeable  below  the 
surface  is  a  draft-flue  for  the  earth.  The  penetration  of  the 
air  through  the  earth  is  promoted  and  facilitated  by  every 
such  house.  The  warmer  the  air  inside,  and  the  more  surely 
protected  against  the  external  and  free  atmosphere,  the  more 
rapid  the  current  of  ground-air  through  the  foundations  and 
ground-floors  of  such  dwellings.  It  is  a  more  constant  evil 
during  the  colder  than  during  the  warmer  seasons,  because  of 
the  greater  difference  between  the  temperature  of  the  houses 
and  that  of  the  ground-air.  Freezing  of  the  surface  offers  but 
little  obstruction  to  the  circulation  of  ground-air,  and  none 
at  all  to  its  horizontal  movement.  In  fact,  it  has  been  sup- 
posed by  some  to  favor  its  escape  into  dwellings  and  through 
the  warmer  surfaces.  No  explanation  entirely  satisfactory 
has  yet  been  presented  for  the  greater  prevalence  and  iuteuser 
forms  of  smallpox,  scarlet  fever,  and  other  exanthematous 
diseases  during  the  colder  than  during  the  warmer  seasons. 
The  greater  number  of  persons  in,  and  the  more  constant 
occupancy  and  diminished  ventilation  of  dwellings,  are  ad- 
mitted and  important  agencies.  Why  may  not  the  ground- 
air,  carrying  these  contagious  and  penetrating  these  dwellings, 
prove  a  factor  in  their  dissemination  equally  as  coustaut  and 


198  ESSAYS  AND  ADDRESSES. 

potential  ■?  If  it  be  a  fact,  as  anuounced  by  Klebs  and 
Tomraasi-Crudeli,  that  the  malarial  poison  is  found  iu  the 
soil  of  malarious  regions  during  the  seasons  when  the  tem- 
perature of  the  atmosphere  is  below  that  believed  to  be  neces- 
sary for  the  generation  of  this  miasma,  why  may  not  the 
greater  facility  and  certainty  of  the  admission  of  ground-air 
into  houses  at  such  times  explain  the  prevalence  and  con- 
stantlv  recurring  attacks  of  malarial  diseases  during  these 
periods  ?  The  fact  is  easily  demonstrated  that  many  occu- 
pants of  houses  standing  upon  made  or  insufficiently  drained 
lands  are  sufferers  from  persistent  and  ill-defined  ailments, 
from  which  relief  is  only  secured  by  change  of  dwelling. 
And,  surel}^,  if  the  discoveries  announced  by  Pasteur  have 
any  substantial  basis,  the  conveyance  of  the  germs  of  disease 
in  this  manner  is  not  only  possible  but  probable.  It  may 
not  be  practicable  to  prevent  entirely  the  pollution  of  the 
ground-air,  but  it  can  be  reduced  to  a  minimum,  and  the  air 
of  dwellings  can  be  securely  protected  from  such  contamina- 
tion by  proper  construction.  Greater  cleanliness  of  the  soil 
can  be  secured  by  the  prohibition  of  cesspools,  privy-boxes, 
and  pits,  and  of  other  collections  and  deposits  of  decaying 
and  putrescible  material,  either  upon  or  beneath  its  surface. 
A  properly  arranged  and  adequate  system  of  sewerage,  and 
compulsory  legislation  requiring  a  connection  with  every  such 
depository  and  receptacle  will  accomplish  much  in  preventing 
soil-pollution.  A  system  of  underground  drainage  will  dis- 
pose of  the  surplus  soil-water,  lower  the  level  of  soil-saturation, 
and  purify  the  earth  by  promoting  ventilation  and  a  more 
rapid  percolation  of  the  rainfall  to  greater  depths.  The  pipes 
of  such  a  system  when  not  carrying  water  will  carry  air,  and 
thus  aeration  and  ablution  of  the  soil,  and  dilution  and  diffu- 
sion of  the  filth,  will  accomplish  at  least  a  partial  disinfection. 
The  air  of  dwellings  must  be  considered  in  its  relation  to 
the  surrounding  atmosphere  as  well  as  to  the  ground-air. 
This  relates  especially  to  the  study  of  the  processes  of  catch- 
ing cold.      The  air  of  a  dwelling  cannot  be  purer  than  the 


1<:SSA  YS  AM)  AI)I>ltl':SSKS.  JUO 

atmoHj)lH'n'  wliidi  HiirroiindH  it,  and  i'h  altered  (Petlenkoffcr) 
and  deteriorated  l»y  vvliatfjver  goes  on  in  it.  It  ih  j)f)lliitwl 
})y  the  admixture  of  substances  and  altered  in  eliemic-al  eorn- 
posilion  after  it  enters  the  hons(!.  Oxygen  i.s  consumed  hy 
respiration,  li<!;hta,  and  fires.  Carbonic  aeid  and  water  are 
exhaled  from  the  lunji;s  and  skin,  and  various  otiier  extra- 
neous matters  are  (b^rived  from  the  uneleardy  arui  caniless 
management  and  disposal  of  the  waste  and  refuse.  These 
alterations  are  partly  unavoidable.  Interchange  is  constantly 
taking  place  between  the  air  outside  and  inside.  No  house 
can  be  protected  against  this  change  of  air,  and  if  the  atmos- 
phere was  excluded,  it  would  not  be  habital)le.  Ventilation 
is,  however,  in  very  many  habitations  insufficient,  because  of 
overcrowding,  defects  of  construction,  and  neglect  of  prevent- 
able sources  of  pollution  ;  and  it  is  a  great  waste  to  consume 
fresh  air  in  the  ae'ration  and  dispersion  of  such  avoidable  con- 
tamiuations. 

The  air,  both  inside  and  outside  of  dwellings,  is  always  in 
motion,  though  this  is  not  always  manifest  to  our  senses. 
Ventilation  is  eifected  by  the  constant  interchange  due  to 
motion  produced  by  differences  of  temperature  and  by  the 
force  of  the  wind,  and  is  regulated  by  the  porosity  of  the 
walls  and  the  size  and  number  of  the  apertures  and  archi- 
tectural openings.  The  difference  of  temperature  and  the 
force  of  the  wind  frequently  supply  the  insufficiency  of  the 
one  or  the  other.  By  these  means  spontaneous  ventilation 
ought  to  be  sufficient  for  the  purposes  of  health,  provided  the 
greatest  cleanliness  and  abstention  from  superfluous  pollutions 
are  observed. 

There  are,  however,  many  circumstances  and  conditions 
which  interrupt  and  impede  this  necessary  and  wholesome 
interchange.  In  this  city  damp  and  wet  walls  are  among 
the  most  frequent  disturbances  of  ventilation.  "Water  fills 
the  pores  of  the  brick,  stone,  and  mortar,  and  closes  the  in- 
lets and  outlets  of  these  porous  materials  so  generally  used  in 
the  building  of  houses.    This  water  is  mainly  derived,  tiirough 


200  ^SSA  YS  AND  ADDJRESSES. 

the  permeable  foundations,  from  the  ground- water,  which  in 
so  many  places  is  excessive  and  near  the  surface.  But  damp 
walls  not  only  prevent  the  passage  of  air,  but  disturb  the  heat- 
economy  of  the  bodies  of  the  dwellers.  Water  is  a  better 
conductor  of  heat  than  air,  and  wet  clothes  are  colder  than 
dry.  Wet  walls  abstract  and  absorb  more  heat  than  dry 
walls.  They  reduce  the  temperature  of  the  room  and  accel- 
erate the  loss  of  animal  heat,  thus  producing  a  too  rapid  cool- 
ing of  the  whole  or  parts  of  the  body.  In  this  circumstance 
many  cases  of  sickness  find  their  cause.  Colds,  catarrhal  in- 
flammations, rheumatisms,  and  kidney  diseases  (prevalent 
forms  in  this  city)  are  quite  common  among  the  occupants 
of  damp  dwellings. 

Ventilation  and  draught  are  not  the  same.  Both  imply 
motion  of  the  air.  Ventilation  is  the  necessary  chauge  of 
air  in  a  closed  space  taking  place  without  perception  of  its 
movement.  Draught  is  the  motion  of  air  made  manifest  to 
sensation,  and  differs  from  wind  only  in  force  and  velocity. 
The  occupants  of  wet  and  damp  houses  frequently  complain 
of  and  ascribe  their  ailments  to  draught,  when  in  fact  there 
is  insufficieut  exchange  of  inside  and  outside  air,  because  of 
the  filling  of  the  pores  of  the  walls  with  water.  In  addition 
to  vitiation  of  the  air  in  such  houses,  there  are  more  rapid 
absorption  of  heat  and  lowering  of  the  temperature,  causing 
local  and  one-sided  radiation  of  the  body-heat  and  the  conse- 
quent disturbances  of  the  heat-economy,  thus  producing  ail- 
ments which  are  ascribed  to  malaria. 

In  whatever  respect  soil-saturation  may  be  considered,  its 
influences  and  effects  are  detrimental  to  health.  Agricul- 
turists have  long  since  recognized  the  injury  of  surplus  soil- 
moisture  to  plant-life,  and  experience  has  shown  that  such 
lands,  usually  the  richest  in  the  elements  of  plant-food,  can 
only  be  made  available  by  under-drainage  ;  but  not  until 
recently,  and  onl_y  by  comparatively  few  even  now,  have  its 
dangers  to  human  health  aud  life  been  clearly  understood. 
Only  by  the  study  of  the  topographical  distribution  of  diseases 


K'^SA  YS  AND  ADDllEiifiES.  201 

and  (leatliH  Iuih  llio  diniot  connection  iK'twcfii  Hoil-natiira- 
tion  and  pulmonary  constimplion  been  awMtrtained.  And 
though  shown  to  Ix;  true  in  njgard  to  large  regions  and  sec- 
tions, hut  few  ar(!  yet  willin;^  to  believe  it  efpially  true  of 
single  habitations.  Until  the  doctrine  tliat  diseases  are  more 
frequently  attributable  to  personal  and  domiciliary  unhy- 
gienic conditions  than  to  natural  causes  is  more  universally 
accepted,  but  httle  can  be  accomplished  by  preventive  medi- 
cine. 

Morbility  and  mortality  bear  a  constant  relation  to  the 
density  of  population.  This  is  a  factor  in  all  cities.  When 
to  a  sujKH-abundant  and  unclean  population  are  added  the 
effects  of  an  inadequate  provision  for  the  removal  of  the 
various  excreta,  the  air  becomes  permanently  ladened  with 
noxious  elements.  This  is  a  city  for  politics,  aesthetics,  and 
the  sciences,  and  not  for  commercial  and  industrial  pursuits, 
and  hence  ought  to  be  comparatively  free  from  any  foul  mat- 
ters and  effluvia,  which  are  the  uuavoidable  accessories  of  the 
latter  occupations.  The  plan  of  the  city  secures  constant 
agitation  of  the  air  and  free  ventilation.  Its  wide  streets 
and  broad  avenues,  with  their  numerous  intersections  form- 
ing large  open  spaces,  create  interchanging  currents.  These, 
together  with  the  large  area  of  public  reservations,  promote 
the  diffusion,  dilution,  and  escape  of  the  insalubrious  and 
detrimental  exhalations.  As  a  cause  of  disease  the  density 
of  the  population  can  never  become,  as  in  more  populous 
cities,  the  predominating  influence.  The  area  of  unoccupied 
territory  will  always  be  largely  in  excess  of  the  occupied. 
Nevertheless,  as  the  value  of  real  estate  advances,  the  cupidity 
of  owners  will,  in  small  districts  or  single  squares,  unless  re- 
strained by  law,  establish  numerous  foci  for  the  germination 
and  dissemination  of  infectious  germs  by  the  subdivision  of 
lots,  the  opening  of  new  streets,  the  conversion  of  alleys  into 
others,  and  the  erection  of  tenement-houses  upon  every  avail- 
able space.  I  might  even  now  cite  such  localities.  The 
proper  adjustment  of  the  number  of  residents  to  the  area. 


202  ESSAYS  AND  ADDRESSES. 

together  with  the  vigorous  enforcement  of  sanitary  regula- 
tions, would  greatly  lessen  the  morbility  and  mortality,  espe- 
cially in  those  districts  where  overcrowding  and  filth  prevail. 
It  is  a  great  mistake  to  suppose  that  we  have  no  personal 
concern  in  nuisances  on  neighbors'  premises.  They  can 
poison  the  ground,  air,  water,  and  atmosphere,  and  this 
poisoned  air  may  permeate  the  earth  and  convey  to  other 
dwellings  the  germs  of  disease.  Our  senses  may  not  detect 
the  noxious  effluvia,  but  the  enemy  may  find  its  victim  all 
the  same. 

It  may  be  asked,  How  abate  the  evils  complained  of  ? 
The  answer  is  easy.  Reclaim  the  river-flats;  complete  the 
system  of  storm- water  conveyance  and  city  sewerage;  hasten 
to  completion  the  grading  and  improvement  of  streets  ;  elevate 
the  bed  of  Pennsylvania  Avenue  from  the  Capitol  to  West 
Fifteenth  Street ;  discontinue  the  use  of  impermeable  mate- 
rial in  the  pavement  of  carriageways  and  sidewalks;  estab- 
lish and  execute  a  system  of  subsoil-drainage ;  obliterate  or 
subsoil  the  parks  along  the  building-lines  ;  improve  and 
adorn  the  reservations ;  extend  the  Capitol  park  south  to 
the  river-shore  and  connect  it  with  the  reclaimed  flats  alonsr 
the  Potomac  ;^  prohibit  by  stringent  regulations  the  erection 
of  buildings  with  permeable  ground  or  underground  floors 
and  walls  below  the  surface  of  the  streets  ;  straighten  the 
channel  of  Rock  Creek  by  cutting  across  the  horseshoe 
bend  at  P  Street ;  hide  its  filthy  shore  by  an  arch,  and  open 
a  park  along  its  course ;  and  emptying  the  Chesapeake  and 
Ohio  Canal  into  the  Potomac  above  the  limits  of  Georgetown, 
and  destroy  the  unsightly  observation  of  this  cesspool  of  filthy 
water  and  many  steuches. 

This  is  the  capital  of  a  great,  growing,  and  prosperous 
nation,  beautiful  in  design,  and  susceptible  of  greater  and 
more  magnificent  embellishments.     Every  citizen  shares  the 

1  These  additions,  with  the  Monument  grounds,  Mall,  and  Botanic  Garden,  would 
make  an  immense  national  park  and  pleasure-ground,  encircling  South  Washington 
and  extending  from  the  Capitol  to  the  Executive  Mansion. 


KS,SAYS  AND  ADDILKSSICS.  203 

wisli  for  its  ,snl)Ht!inti;il  iinprovcriwiiit  and  adornrTumt  <'orii- 
iTi(Mi,siii'at(!  with  i(H  im|)()rlancc  and  f-apahilitifis.  TIm;  time; 
may  not  Ix;  very  niiTiolo,  and  will  Ix;  iia-^lciu'd  Ity  tlic  HjX'ody 
execution  of  the  nceessary  .sanitary  reforms,  when  the  Hiir- 
rotinding  elevations  will  be  eovered  witli  winter  re.sidenees 
and  snmmer  villas,  rivalling  in  beauty  and  grandeur  the  taste 
and  display  exhibited  along  the  cliffs  at  Newport.  Tinder 
the  present  form  of  government  the  sanitary  condition  has 
been  greatly  improved,  but  this  great  nation  cannot  afford  to 
peraiit  the  long  continuance  of  the  manifest  and  admitted 
causes  of  disease  which  environ  and  underlie  its  capital, 
furnishing  a  constant  menace  to  the  health  and  lives  of  its 
chosen  agents  and  legislators.  Nor  should  the  permanent 
residents  stand  idle  and  unconcerned,  while  the  rising  genera- 
tions are  growing  up  under  the  baneful  and  enervating  influ- 
ences with  their  multiform  phases  of  disease,  interrupted  devel- 
opment, and  broken  constitutions.  The  expenditure  required 
to  complete  the  necessary  sanitary  reform,  under  the  direction 
of  the  most  skilful  supervision,  would  be  a  magnificent  con- 
tribution by  a  nation  of  fifty  millions  of  people  to  sanitary 
science,  preventive  medicine,  and  the  welfare  of  a  common 
humanity. 

In  the  foregoing  I  have  endeavored  to  set  forth  the  natural 
and  artificial  unhygienic  conditions  of  this  locality  ;  and  have 
indicated  in  the  title  that  I  ascribe  the  prevalence  of  two 
classes  of  disease  to  these  causes,  one  being  due  to  the  con- 
tamination of  the  air  with  a  special  poison,  aud  the  other  to 
the  catching  of  cold.  I  have  also  stated  that  the  clinical 
pictures  frequently  presented  by  cases  aud  forms  of  these 
different  classes  of  disease  were  so  alike  that  differentiation 
of  cause,  so  necessary  for  success  in  treatment,  was  not  always 
easily  arrived  at.  I  approach  the  discussion  of  the  clinical 
branch  of  the  subject  with  diffidence,  because  I  am  well 
aware  that  the  conclusions  to  which  my  studies  have  led  me 
will  antagonize  the  opinions  of  some  of  my  most  distinguished 
professional  brothers;  nevertheless  I  have  no  new  theories  to 


204  ESSAYS  AND  ADDRESSES. 

promulgate,  and  will  confine  myself  solely  to  the  narration  of 
my  own  clinical  observations. 

The  detrimental  influences  which  environ  our  population 
do  not  belong  exclusively  to  this  locality.  One  could  not 
travel  far  iu  any  direction  from  this  centre  without  finding 
other  communities  no  less  unfortunately  situated.  Many 
cities,  towns,  and  neighborhoods  throughout  the  land  present 
natural  conditions  equally  and  even  more  unsafe  to  health 
and  life,  and  exhibit  graver  errors  in  hygiene,  which  yield 
annually  a  richer  harvest  in  deaths  than  we  have  as  yet 
offered;  but  if  others  have  suffered  more  or  less,  it  is  no 
reason  why  we  should  delay  in  securing  all  that  science  can 
promise  in  the  prevention  of  disease.  To  accomplish  this  we 
must  first  ascertain  the  cause  or  causes.  If  in  the  preceding 
picture  I  have  depicted  the  work  of  nature  and  operations  of 
man  in  their  proper  colors,  I  may  hope  to  interest  those  con- 
cerned sufficiently  to  arouse  them  to  the  dangers  which  beset 
the  present  and  may  befall  future  generations,  and  will  have 
discharged  a  duty  which  professional  observation,  experience, 
and  opportunities  have  imposed. 

Of  the  presence  in  this  locality  of  the  two  causes  and  twa 
classes  of  disease  referred  to  there  can  be  no  doubt;  but 
our  knowledge  of  the  nature  and  infectious  quality  of  the 
malarial  poison  does  not  permit  an  exact  determination  of 
the  relation  of  this  agency  to  the  effects  ascribed  to  it.  We 
witness  certain  results  in  constant  association  and  connection 
with  an  unbroken  chain  of  known  conditions  and  circum- 
stances, and  from  these  data  deduce  an  hypothesis  which 
affords  a  reasonable  explanation.  This  hypothesis  involves 
two  unascertained  quantities,  the  genesis  and  modus  operandi 
of  miasma. 

The  "^  catching  of  cold,"  induced  by  the  unusual  removal 
of  animal  heat,  either  through  the  external  or  internal  sur- 
face, has  long  been  recognized  as  an  etiological  factor.  The 
functions  of  heat-production  and  -dissipation  are  regulated 
by  nerve-centres.     In  health  the  equilibrium  is  maintained 


ESSA.  Y,S  A  Nl)  A  I >  DRESSES.  205 

witliiii  certain  pliysiolojjjical  limits,  and  tliou^^li  tlic  tfjinjXTa- 
ture  of  the  body  is  Hubjwit  to  frccpiont  fluctuations  within 
tlioso  limits,  the  changes  are  spciodily  equalized.  'I'lie  tem- 
perature of  all  |)arts  of  the  same  body  is  not  uniform  at  the 
same  time,  owin<^  to  tlie  diirerent  amount  of  heat  carried  by 
the  blood  to  the  various  parts,  to  the  varying;  conductivity  of 
tissue,  and  the  difference  in  local  prodiuition  and  loss  of  heat; 
but  a  normal  range  is  preserved  in  health,  tliouj^li  between 
lesser  maxima  and  minima  in  parts  remote  from  than  in  those 
parts  near  the  heat-res^ulating  centres.  Heat-production  is 
increased  by  muscular  effort,  lessened  by  rest,  and  is  least 
during  sleep.  The  increased  production  must  be  compensated 
by  increased  loss,  and  the  lessened  production  by  greater 
protection  of  the  body,  else  the  heat-economy  becomes  dis- 
turbed and  injury  ensues,  affecting  either  the  whole  or  a  por- 
tion of  the  body.  The  body  loses  heat  by  radiation,  conduc- 
tion, and  evaporation,  which  may  be  influenced  unfavorably 
by  external  and  internal  agencies.  The  external  influences 
may  be  expressed  in  lovv  temperature,  motion  of  the  air,  and 
moisture.  Either  may  prove  sufficient,  but  disorder  more 
certainly  follows  their  combined  influence.  It  is  not  neces- 
sary that  either  or  all  should  be  of  maximum  intensity,  for 
slight  cooling  of  the  surface  by  constant  change  of  surround- 
ing air,  increased  evaporation  from  the  skin  moistened  with 
perspiration,  or  increased  conduction  promoted  by  a  cooler 
medium  in  contact,  does  in  numerous  instances  produce  some 
one  of  this  group  of  maladies.  Nor  is  it  required  that  the 
whole  surface  should  be  cooled  ;  a  leg  or  arm,  the  head  or 
back  of  the  neck  may  be  sufficient.  Numbers  of  persons 
have  felt  the  pangs  of  toothache  rekindled  by  a  puff  of  cold 
air  upon  the  cheek  over  a  decayed  tooth,  or  contracted  a  cold 
in  the  head  from  cutting  off  the  hair  in  cold  weather,  or  a 
bronchitis  from  wetting  the  feet,  even  in  midsummer.  While 
it  is  usual  that  the  part  contiguous  to  the  chilled  sui-faoe  suf- 
fers, it  is  not  the  invariable  law.  The  place  or  part  of  least 
resistance,  the  Aveaker  organ  or  tissue,  though  remote  from 


206  ESSAYS  AND  ADDRESSES. 

the  part  exposed  to  the  chiUing,  will  frequently  exhibit  the 
injury  sustained.  Subject  a  number  of  persons  of  equal  age 
and  vigor  and  of  average  health  to  the  same  cooling  influence, 
one  will  escape  unhurt,  another  with  a  slight  sore-throat,  a 
third  will  suffer  a  severe  rheumatism,  a  fourth  will  pass  the 
ordeal  of  an  acute  pneumonia,  and  the  fifth  will  succumb  to 
a  pleurisy,  the  localization  in  each  case  depending  upon  indi- 
vidual susceptibility  and  the  lesser  resistance  of  different 
parts.  If,  says  Seitz,  a  sensory  nerve-tract  be  implicated, 
rheumatic  pains  or  neuralgia  may  follow  ;  should  the  vaso- 
motor centre  be  involved,  congestion  of  a  special  vascular 
area  may  ensue ;  inflammatory  processes  may  be  ascribed  to 
the  transfer  of  the  impression  to  the  nutritive  nerves,  and  if 
the  heat-regulatiug  centre  be  depressed,  fever  may  result.  It 
is  not  necessary  that  the  surface-refrigeration  should  be  long 
continued.  The  sudden  transition  from  a  warm  to  a  cool 
medium,  as  the  passing  from  an  overheated  room  to  a  cold 
entrance-hall,  or  into  a  strong  current,  even  though  the 
change  be  of  momentary  duration,  will  suffice  in  a  suscep- 
tible person,  or  a  person  otherwise  healthy,  who  may  be  the 
unfortunate  possessor  of  a  loeus  minoris  i-esidentioe.  It  is, 
nevertheless,  a  fact  that  few  can  resist  the  influence  of  an 
active  and  protracted  loss  of  body-heat.  When  at  rest  or 
during  sleep  surface-cooling  is  more  certainly  and  quickly 
injurious  than  during  exercise,  because  the  loss  of  heat,  even 
though  it  may  not  be  manifest  to  our  senses,  is  not  compen- 
sated by  increased  production.  During  exercise  the  circula- 
tion of  the  blood  is  stimulated  and  surface-heat  is  maintained; 
but  if  perspiration  is  induced,  evaporation  is  increased,  and 
this  contributes  to  a  more  rapid  cooling,  especially  if  the  ex- 
ercise is  followed  by  sudden  rest,  and  the  cooling  is  promoted 
by  the  removal  of  overgarments,  and  the  rest  be  sought  in 
currents  of  air.  Nor  is  it  necessary  that  the  sufferer  should 
be  admonished  by  a  rigor.  The  cases  of  sickness  following 
loss  of  heat  are  more  frequently  without  than  with  the  occur- 
rence of  a  chill,  and  it  is  this  class  of  disorders  which  is  so 


J'JSSA  YS  AND  ADDRESSES.  207 

proue  to  asBiiinc  chroiiic  and  iiiaHkcd  fonris,  (liially  develop- 
ing either  into  inlra(tlultl(!  or  incurable  diseaHCH.  A  hroiieliial 
catarrh,  cHpeeiaily  in  oik;  inheriting  tiu!  |)recliKj)OHition  to 
phtliisis  puhiionalis,  .so  trifling  as  not  to  attract  attention, 
may  leave  hidden  in  the  lung-structure  a  caseous  focus  too 
small  to  be  recognized  and  located,  but  which  by  constant 
accretions  from  subsequent  equally  trivial  and  repeated  at- 
tacks, each  succeeding  one  the  more  probal^le  because  of  one 
or  more  having  preceded,  until  finally  the  caseous  formations 
break  down,  and  the  previous  unsuspected  disease  passes  be- 
yond recovery.  This  chain  of  unrecognized  beginning,  im- 
perceptible progress,  and  final  explosion  may  have  had  its 
cause  in  constantly  repeated  slight  surface-coolings  during 
rest  and  sleep,  in  apartments  securely  protected  against  wind 
and  storm,  but  surrounded  by  walls  resting  upon  soil  satu- 
rated with  water.  The  early  history  of  such  a  case  is  usually 
that  of  enfeebled  health,  with  recurring  losses  and  gains, 
trivial  discomforts,  passing  indisposition,  unusual  suscepti- 
bility to  atmospheric  changes,  digestive  irregularities,  summer 
improvements  and  winter  relapses,  and  gradual  but  progres- 
sive blood-changes,  marked,  in  the  further  progress,  by 
aufemic  and  masked  disorders  of  graver  import,  all  of  which 
are  frequently  ascribed  to  malarial  contamination,  and  the 
methods  of  prevention  and  cure,  based  upon  a  mistaken  cause, 
promote  and  aggravate  the  morbid  processes.  The  respira- 
tory are  not  the  only  organs  which  suffer  from  equally  slight 
surface-coolings.  The  alimentary  tract  is  quite  as  often 
affected,  and  among  very  young  children  the  mortality  from 
this  group  of  maladies  is  even  larger  than  from  diseases  of 
the  respiratory  organs.  No  one  can  doubt  the  agency  of 
sudden  refrigeration  in  producing  catarrh  of  the  mucous 
membranes ;  and  the  complex  conditions  of  alimentation  and 
digestion,  which  so  constantly  imperil  the  life  of  infants  at 
all  seasons  of  the  year,  expose  the  alimentary  tract  especially 
to  the  detrimental  influences  of  sudden  loss  of  body-heat.  In 
those  cities  throughout  the  climatic  region  of  this  country, 


208  ESSAYS  AND  ADDRESSES. 

where  infantile  diarrhoeas  are  most  prevalent  and  fatal,  the 
fluctuations  of  temperature  during  the  summer  season  are 
most  acute  and  intense,  and  there  seems  to  be  a  correspond- 
ence between  the  percentages  of  mortality  and  the  frequency 
and  violence  of  the  sudden  falls  of  temperature/  In  this 
city  the  maps  showing  the  topographic  distribution  of  deaths 
show  a  constant  connection  between  the  number  of  deaths 
from  diarrhoeal  disease  and  inadequate  soil-drainage.  The 
causes  of  attacks  of  cold  are  not,  however,  limited  to  the 
unavoidable  depressions  of  the  temperature  of  the  atmos- 
phere, excessive  soil-moisture,  wet  cellars  and  foundations, 
and  damp  sleeping-apartments.  The  mother  or  nurse  will 
insist  that  the  child  could  not  have  taken  cold  because  it  was 
well  wrapped  when  taken  out,  or  was  in  a  carriage  with  all 
the  windows  closed,  or  had  not  been  out  for  several  days, 
but  had  been  kept  in  a  thoroughly  warmed  room.  In  the 
closest  and  warmest  rooms  there  are  draughts.  The  hotter 
the  fire  in  the  grate  the  stronger  the  draughts  converging  from 
the  various  openings  toward  the  chimney.  Usually  they  are 
strongest  near  the  floor,  the  cold  air  finding  entrance  through 
the  spaces  about  the  doors  and  windows.  In  an  overheated 
room  the  child  may  have  been  confined  and  passed  the  greater 
part  of  the  day  playing  on  the  floor,  exposing  first  one  and 
then  another  heated  and  moist  surface  to  the  draughts  trav- 
ersing the  floor ;  or  it  may  have  been  out  on  a  long  walk 
clad  with  unusual  care  and  too  warmly,  and  immediately 
upon  returning,  fatigued  and  perspiring,  its  outer  garments 
had  been  removed,  and  it  had  rested  quietly  or  slept ;  or  the 
infant,  rolled  up  in  cloaks  or  furs,  may  have  been  carried  out 
closely  hugged  in  the  arms  of  the  nurse,  from  whose  body 
additional  heat  was  supplied.  On  returning,  asleep,  and  moist 
all  over,  its  outer  wrappings  were  quickly  removed,  and  the 
child  placed  to  sleep  in  the  crib.  In  either  case  a  notable 
and   rapid   cooling  would   take   place,  and   the  detrimental 

1  Mortality  of  Young  Children  :  Its  Causes  and  Prevention.    By  the  Author.    Sani- 
tary care  and  treatment  of  children  and  their  diseasas. 


ESSAYS  AND  ADDRESSES.  209 

cffoct  may  Ix;  cuiickly  (.'xliihilcd  in  a  Horc-tliroat,  an  caradif, 
a  ra])i(lly  (hivolopcd  fever,  or  durint^  the  ni^lit  by  croup, 
or  tlie  next  day  by  a  nasal,  intestinal,  or  hr(»iicliial  r:ii;irrli, 
or,  even  worse,  a  pneninonia. 

The  defined  forms  of  malarial  disease  belong  to  the  class  of 
intermittent  and  icmittent  fevers,  and  tin;  indefinite  forms 
eompreliend  many  of  the  neural<rie,  ^astro-intestinal,  an.'emio, 
and  masketl  alTeetions.  The  febrile  conditions  are  usually 
easily  distinguished  by  their  forms  and  course.  It  is,  how- 
ever, a  well-known  fact  that  in  malarious  regions  many  dis- 
eases to  which  malaria  bears  no  causal  relation  frequently 
exhibit  disturbing  perturbations  in  great  variety,  due  to  its 
detrimental  influence.  It  is  also  a  recognized  fact  that  in 
such  localities  the  catching  of  cold  will  produce,  in  those 
who  have  previously  suffered,  relapses  and  recurrent  attacks, 
and  will  hasten  and  promote  the  development  of  some  form 
of  malarial  disease  in  those  in  whom  the  poison  may  have, 
apparently,  remained  dormant.  These  circumstances  long 
ago  led  to  the  hypothesis,  which  has  been  occasionally  re- 
vived, that  the  diseases  ascribed  to  marsh-miasm  were  due  to 
the  disturbances  of  the  heat-economy  caused  by  temperature- 
changes  ;  that  malaria  was  nothing  more  than  the  sudden 
chilling  of  the  body  previously  subjected  to  a  continuous  high 
temperature.  The  few  advocates  of  this  theory  have  not  sub- 
mitted it  to  a  crucial  test,  but  have  mainly  relied  upon  the 
discrepancies  in  the  testimony  in  support  of  the  generation 
and  absorption  of  a  miasm,  and  the  aberrant  occurrences 
of  paroxysmal  fever  under  circumstances  and  in  localities 
where  the  causal  relation  of  miasm  could  not  be  established, 
but  seemed  to  be  negatived  by  the  environment.  It  is  un- 
doubtedly true  that  many  cases  have  appeared  at  places  and 
times  which,  either  because  of  lack  of  knowledge  in  regard 
to  the  development  and  dissemination  of  the  poison  or  of 
omissions  in  the  clinical  histories  of  the  cases,  could  not  be 
accounted  for  upon,  or  reconciled  with,  the  facts  believed  to 
be  established  in   regard  to   miasmatic  contamination.      But 

14 


210  ESSAYS  AND  ADDRESSES. 

as  yet  there  is  uo  instance  of  malarial  fever,  as  nnderstood  by 
physicians,  having  been  produced  in  a  person  known  to  be 
free  from  the  poison,  either  at  sea,^  away  from  the  reach  of 
the  land  breezes,  on  high  altitudes,  or  in  situations  exempt 
and  sufficiently  remote  from  the  sources  of  generation,  by 
temperature-changes,  however  sudden,  violent,  and  frequent 
their  occurrence.  This  theory  is,  furthermore,  distinctly 
contradicted  by  the  widespread  prevalence  of  malarial  dis- 
eases during  those  seasons  and  in  those  places  where  the  con- 
ditions necessary  for  the  generation  of  miasm  are  known  to 
be  present,  as  well  in  those  places  subject  to  small  as  in  those 
subject  to  larger  ranges  of  temperature;  by  the  invasion  of 
sections  previously  exempt,  where  artificial  disturbances  of 
the  natural  topography  or  long-continued  occupancy  and  cul- 
tivation may  have  supplied  the  needed  element,  but  where 
the  conditions  of  temperature  do  not  now  differ  from  those 
in  times  past ;  by  the  greater  prevalence  and  more  intense 
forms  as  the  equator  is  approached,  where  the  temperature  is 
more  uniformly  high,  the  diurnal  changes  less  marked,  and 
the  total  movement  of  the  wind  is  small ;  by  the  marked 
variations  in  prevalence  in  different  years  in  well-known 
malarious  regions  subject  annually  to  the  same,  or,  at  most, 
but  inappreciable  differences  of  thermal  conditions,  but  char- 
acterized by  larger  areas  of  soil-upheaval  and  by  greater 
exposure  of  miasmatic  foci ;  by  the  comparative  protection 
afforded  by  intervening  hedges  and  groves  to  the  occupants 
of  dwellings  which,  like  others,  are  situated  in  close  prox- 
imity to  marshes  and  subject  to  like  conditions  and  changes 
of   temperature  f    by  the   lesser   prevalence,    under   similar 

1  Sir  Gilbert  Blane,  in  speaking  of  bilious  remittent  fever,  says :  "  I  have  known  a 
hundred  yards  in  a  roadstead  raake  a  difference  in  the  health  of  a  ship  at  anchor  by 
her  being  under  the  lee  of  marshes  in  one  situation,  and  not  in  another.  It  is  diffi- 
cult to  ascertain  how  far  the  influence  of  vapors  from  woods  and  marshes  extends, 
but  there  is  reason  to  think  that  it  is  to  a  very  small  distance.  When  the  ships 
watered  at  Rock  Fort  they  found  that  if  they  anchored  close  to  the  shore,  so  as  to 
smell  the  land  air,  the  health  of  the  men  was  affected,  but  upon  removing  two 
cables'  length  no  inconvenience  was  perceived."  (Bartlett :  Treatise  on  Fevers,  p.  395.) 

2  Of  the  many  recorded  illustrations  the  following  may  be  cited  :  "  Mr.  P.  E.  had 
negro-quarters  situated  on  the  first  prairie  elevation  above  the  low  grounds  of  a  small 


f'JSSA  VS  A  Nl)  A  DDIU'JSS/'JS.  21 1 

(!lim;i(i(!  iufliKMidcs,  aloii^  tlw.  h<)\<\  shoroH  of  hir^o  hodicH  of 
runiiinj^  water  tliaii  along  tin;  delta,  bogf^y,  and  low  land.s  of 
smaller  stnjams  with  far  less  evaporating-surfaces ;  by  the 
indnencie  of  different  expo.snres  of  human  habitation.H  to  the 
j)revailing  winds  in  malarious  distriets,  the  oeeupantsof  those 
exposed  to  the  direct  current  of  the  wind  suffering  more  than 
those  of  the  dwellings  sheltered  by  position  or  otherwise; 
and,  lastly,  by  the  well-known  fact  that  the  inhabitants 
of  the  territory  contiguous  to  malarious  marshes,  swamps, 
ponds,  and  rivers  suffer  less  in  those  seasons  when  ,sn(;li  places 
are  filled  or  overflowing  with  water,  when  the  tlicrmo-hygro- 
raetric  conditions  are  most  ))ronounced,  than  during  those 
seasons  when  only  partially  filled  and  more  or  less  of  their 
area,  covered,  as  it  usually  is,  with  luxuriant  growth  and 
decaying  and  decomposing  vegetable  matter,  is  exposed  to 
high  temperature,  moisture,  and  soil-conditions  favorable  to 
the  generation  of  the  miasm.  These  and  many  other  facts 
are  inexplicable,  except  upon  the  assumption  of  the  genera- 
tion of  a  poison. 

The  theory  that  malarial  diseases  find  their  cause  in  changes 
of  temperature  involves  the  negation  of  all  d^ta  in  support 
of  the  doctrine  of  miasm,  and  necessarily  traces  to  a  common 
cause  and  pathology  the  classes  of  maladies  believed  to  be 
due  to  the  absorption  of  this  poison,  and  those  believed  to 
be  due  to  the  catching  of  cold.  Chilling  of  the  body  and  the 
entrance  of  a  poison  into  the  system  are  different  processes. 
Chill  is  a  common  but  a  constant  initial  symptom  of  malarial 

creek,  the  fourth  of  a  mile  from  the  houses.  This  belt  of  low  ground  frequently  over- 
flowed, causing  water  to  remain  in  holes  over  its  entire  breadth  on  the  subsidence  of 
the  stream  ;  but  it  was  well  shaded  by  a  dense  foliagfe,  the  plantation  lying  on  a 
prairie  in  the  rear  of  the  cabins.  In  the  winter  of  1S42  and  1843  the  trees  between 
the  houses  and  creek  were  cleared  away,  and  up  to  that  time,  some  eight  or  ten 
years,  the  negroes  living  in  this  quarter  had  enjoyed  uninterrupted  health,  a  case  of 
fever  scarcely  ever  occurring.  During  the  summer  of  1843,  the  first  after  the  forest 
had  been  cleared  away,  fever  prevailed  among  the  negroes  with  great  violence,  con- 
tinuing until  frost.  The  negro-quarters  were  afterward  removed  to  the  opposite  side 
of  the  creek,  about  the  same  distance  from  it,  but  with  an  intervening  growth  ot 
timber,  and  no  fever  has  occurred  on  the  place  since."'  (Bartlett :  Treatise  on  Fevers, 
p.  395.) 


212  ESSAYS  AND  ADDBESSES. 

diseases.  The  chill  of  a  miasmatic  ague  is  not  the  alo;or  of 
refrigeratiou.  The  former  is  tlie  cold  stage  of  paroxysmal 
fever ;  the  latter  the  shock  of  heat-loss.  The  ouset  of  one  is 
marked  by  elevation  of  the  body-temperature,  of  the  other  by 
rapid  cooling  of  the  whole  or  part  of  the  body.  One  begins 
with  an  increased  production,  the  other  with  increased  loss  of 
body-heat.  In  one  the  equilibrium  of  body-heat  is  disturbed 
by  overproduction,  in  the  other  by  increased  loss  of  heat. 
How  miasm  introduced  into  the  system  produces  fever  and 
why  too  rapid  cooling  of  the  body  is  followed  by  fever  are  as 
yet  unsolved  problems.  The  phenomena  attending  the  advent 
and  development  of  miasmatic  fevers  denote  disturbances  pro- 
duced by  a  poison  acting  through  the  blood,  which  are  ex- 
pressed in  derangements  of  nutrition,  sensation,  secretion, 
physical  and  mental  activity,  and  in  consumption  of  tissue 
and  loss  of  body-weight.  The  phenomena  following  the 
catching  of  cold  indicate  a  febrile  action  due  to  peripheral 
irritation,  and  are  usually  associated  with  or  caused  by  local 
inflammations.  The  essential  element  of  fever  is  increased 
production  of  animal  heat.  Without  it  fever  cannot  exist. 
Wood  defines  fever  to  be  "  simply  a  state  in  which  a  depress- 
ing poison  or  a  depressing  peripheral  irritation  acts  upon  the 
nervous  system,  which  regulates  the  production  and  dissipa- 
tion of  animal  heat."  It  seems  probable,  as  has  been  shown 
by  Billroth  and  others,  that  inflammatory  fevers  are  due  to 
the  absorption  of  some  product  of  inflammation;  neverthe- 
less, there  are  many  fevers  so  trifling  that  such  a  grave  lesion 
as  blood-poisoning  would  seem  to  be  precluded.  Their  pro- 
vocation by  irritation  of  peripheral  nerves  would  appear  more 
probable,  yet  with  the  progress  of  experimentation  the  irrita- 
tive forms  of  fever  are  gradually  yielding  to  the  proof  of  tox- 
semic  conditions.  As  the  effect  of  the  refrigeration  of  the 
whole  or  of  a  part  of  the  body  is  so  constantly  exhibited  in 
localized  inflammatory  processes,  if  further  research  and  ex- 
perimentation shall  establish  the  connection  of  the  sympto- 
matic fever  of  these  inflammations  with  the  absorption  of  their 


ESSAYS  AND  ADDRESSES.  213 

products,  tlic  sliiu'j)  lines  of  :i  distinot  and  dcfinitf!  patholf>gy 
will  Ix:  drawn  between  the  primary  fovf.Ts  of  malarial  origin 
and  till!  secondary  fcv<!rs  of  r('rri<r(!ration. 

Notwitlistandin;^  our  limited  knowledge  in  re(.nird  to  the 
modus  operandi  of  these  elements  of  cause,  the  difTcrential 
diagnosis  between  the  definod  forms  of  these  two  classes  of 
diseases  can  usually  be  made  at  a  glance.  The  conditions  of 
the  climate,  season,  endemic  constitution  of  the  locality,  ini- 
tial phenomena,  and  mode  of  onset  are  usually  sufficient  to 
determine  the  presence  or  absence  of  malarial  infection.  In 
the  further  progress  of  the  case'  the  paroxysmal  character, 
distinct  periodicity  or  tendency  thereto,  type,  form,  and 
course  of  the  fever,  together  with  the  enlargement  of  the 
spleen  and  liver,  and  appearance  of  pigment  in  the  circula- 
tory system  and  many  organs,  constitute  important  and  usu- 
ally decisive  conditions. 

It  is  not  always  easy  to  determine  when  or  how  one  catches 
cold.  The  exposure  may  not  have  been  accompanied  with 
manifest  chilling  ;  it  may  have  been  prolonged  or  may  have 
been  frequently  repeated.  It  may  have  occurred  during  con- 
tinnous  inclement  weather,  or  may  have  been  caused  by  the 
abandonment  or  change  of  articles  of  clothing.  An  attack 
of  cold  may  be  ushered  in  with  high  fever,  quickly  followed 
by  localized  inflammation  of  a  catarrhal  or  rheumatic  char- 
acter, or  the  fever  may  follow  the  development  of  a  local 
inflammation.  This  reactionary  fever  may  be  out  of  propor- 
tion to  the  extent  of  the  local  mischief,  or  a  simple  feverish- 
ness.  The  fever  may  be  unattended  by  any  local  disease,  but 
characterized  by  general  malaise,  languor,  vague  and  shifting 
pains  and  aches,  shivering  and  chilly  sensations,  cold  feet  and 
hands.  The  chilly  sensations  may  yield  to  warmth,  but  will 
recur  upon  contact  of  colder  temperature.  The  patient  may 
be  warm  in  bed,  and,  upon  exposure  of  a  leg  or  turning  over 
upon  an  unwarmed  part,  a  shiver  will  start  up  from  the  limb 
exposed,  or  the  part  in  contact  with  the  colder  surface,  and 
run  over  the  entire  body,  impressing  itself  most  usually  with 


214  ESSA  YS  AND  ADDRESSES. 

greatest  force  upon  the  back  and  lower  limbs.  There  is  also, 
especially  in  the  milder  cases,  a  tendency  to  sweat.  Com- 
plaint is  frequently  made  of  alternate  sweatings  and  feverish- 
ness,  of  muscular  soreness,  especially  upon  changing  from  a 
position  which  has  been  maintained  for  some  time,  but  which 
disappears  gradually  during  motion,  to  return  again  after  rest ; 
or  of  a  sense  of  bruising,  as  if  one  had  been  badly  beaten, 
which  unfits  the  patient  for  exercise  and  forces  him  to  the 
bed  or  simply  confines  him  to  the  house,  lolling  first  on  the 
bed  and  then  on  the  lounge,  seeking  comfort  under  adverse 
circumstances,  as  fretful  as  a  cross  baby  and  demanding  more 
attention  than  a  half-dozen  ill  persons  usually  require.  These 
attacks  usually  run  a  brief  course  and  terminate  in  the  resto- 
ration of  health.  Though  it  is  not  uncommon  to  witness  a 
protracted  convalescence,  or  frequently  relapses  due  to  neglect 
and  perverse  disregard  of  the  ordinary  care  of  one's  self,  until 
finally  some  intractable  condition  of  ill  health  is  firmly  estab- 
lished. 

A  feverish  cold  may  be  marked  by  the  appearance  of  a 
group  of  vesicles  on  the  lips,  cheeks,  or  about  the  nose;  by 
an  ephemeral  fever  of  very  high  grade,  which  may  go  as  sud- 
denly as  it  came,  leaving  only  a  temporary  exhaustion;  by 
a  copious  and  exhaustive  diarrhoea,  which  may  establish  a 
locality  of  less  resistance,  to  plague  the  possessor  with  fre- 
quent admonitions  of  its  presence ;  by  a  slight  cold  in  the 
head,  altogether  too  trivial  to  account  for  the  intensity  of  the 
fever ;  by  a  fever  continuing  after  the  entire  disappearance 
of  the  local  disease ;  or  by  some  one  of  a  great  variety  of 
local  manifestations  (Seitz)  either  simultaneous  or  successive, 
or  which  may  spring  up  at  intervals,  in  different  localities, 
and  assume  various  forms.  The  fever  induced  by  catching 
cold  may  run  its  course  unattended  with  any  local  manifes- 
tations, but  after  its  complete  subsidence  a  local  disease  may 
develop. 

The  catching  of  cold  may  be  the  "  fons  et  origo"  of  very 
many  indefinite  ailments,  which   mislead  both  patient  and 


/'JSSA  VS  A  Nl>  A  DDRESSES.  216 

physician.  It,  niuy  Ix;  a  jxTHistent  weariness,  a  constant  foil- 
ing of  tire,  an  unremitting  sense  of  fer-blencss,  le8senf<l  vigor, 
mental  and  nervous  perturbations,  attended  with  a  (hipraved 
ap[)etite,  impaired  (hgestion,  and  faulty  nutrition,  followed  by 
blood-impoverishment  and  waste,  with  some  one  or  more  of 
its  many,  midtiform,  complex,  and  erratic  phenomena.  The 
sufferer  seeks  relief  at  sununer-resorts  or  at  special  cure  est^ib- 
lishments ;  by  drugging  with  advertised  ''cure-alls;"  or  by 
running  to  iirst  one  and  then  another  physician.  T>ut  each 
attempt  in  its  turn  fails,  because  the  cause  has  remained  un- 
recognized. One  physician,  mistaking  effect  for  cause,  attacks 
the  stomach  ;  another  seeks  to  replenish  waste  ;  a  third  plies 
the  blood  with  iron  and  chalybeate  Avaters  ;  and  a  fourth,  of 
keener  acumen  than  either  of  his  predecessors,  traces  back, 
link  by  link,  the  long  chain  of  morbid  conditions,  and  finds 
the  cause  to  have  been  a  puff  of  air  which  had  come  ladened 
with  miasma  from  the  river-flats,  and,  true  to  his  instincts, 
doses  with  the  universal  panacea.  These  years  of  more  or 
less  suffering  may  be  occasionally  interrupted  by  a  brief 
period  of  repair,  the  result  of  some  fortunate  occurrence 
which  had  drawn  the  patient  for  a  time  away  from  the  cod- 
dling care  of  overzealous  friends  and  the  damp  and  stagnant 
air  of  the  family  dwelling.  Thus  equipped  with  better  blood, 
an  improved  physique,  and  hopes  brightened  by  the  prospects 
of  recovering,  the  patient  returns  to  the  customary  home  and 
habits  and  soon  relapses,  perhaps  even  faster  than  the  gains 
were  made,  into  an  equally  deplorable  if  not  a  worse  condi- 
tion. Another  change  is  sought,  probably  a  voyage  across 
the  ocean  and  a  tour  through  Europe.  This  chase  after 
health,  with  its  constant  change  of  scenes,  places,  and  habits, 
but  mainly  from  prolonged  absence  from  the  unwholesome 
domicile,  may  establish  a  standpoint  not  far  removed  from 
the  level  of  the  miseries  from  which  nature  refuses  to  recede. 
It  may  be  that,  with  the  changing  conditions  of  life,  health 
will  vibrate  between  bad  and  worse  until  some  fortuitous 
circumstance  transforms  the  habits  of  life  and  changes  the 


216  ESSAYS  AND  ADDRESSES. 

place  of  residence,  aud  then  the  tiiruing-poiut  is  reached  ;  or 
it  may  be  that  some  magic  influence  lightens  the  burden  and 
desolation  of  long  suffering  by  abruptly  separating  subject 
and  cause,  and  life  rejoices  again  in  restored  health  ;  or  it 
may  be  that  the  rays  of  hope  come  and  go  with  the  transitory 
improvements  of  chronic  invalidism  which  progresses  through 
the  regular  gradations  of  an  incurable  and  fatal  disease.  Many 
fatal  heart  affections  have  found  their  beginning  in  slight  sur- 
face-coolings, produced  by  the  proximity  of  damp  walls  in 
sleeping-apartments,  or  the  cold  air  ascending  from  permeable 
ground-floors  and  foundations.  Slight  rheumatic  pains  mark 
the  initial  stage,  then  comes  a  sharp  attack  of  joint-rheuma- 
tism, with  intense  fever  and  heart  complication;  later  the 
murmur  of  valve  lesion  is  heard,  faint  at  first  but  increasing 
with  time,  succeeded  by  degeneration  of  the  heart-muscle, 
and  finally  general  dropsy  with  its  attendant  suffering  closes 
the  distressing  scene. 

Fortunately  for  many  wayward  and  indiscreet  people,  the 
detrimental  effects  of  refrigeration  are  not  always  so  grave 
or  so  disastrous  to  life.  The  minor  ailments  which  are  so 
commonly  ascribed  to  the  unavoidable  and  baneful  influence 
of  malarial  contamination  most  frequently  find  their  cause  in 
the  indiscretions  of  everyday  life.  Women  who  are  accus- 
tomed to  all  the  comforts  that  wealth  can  bestow,  and  who 
take  special  care  to  protect  their  person  when  going  to  walk 
or  drive,  will  go  to  an  evening  entertainment  with  bared 
necks,  arms,  and  heads,  with  thin  boots  or  slippers,  and  with 
insufficient  underclothing,  in  conformity  with  the  usages  of 
society.  But  even  this  reprehensible  custom  would  not  so 
often  entail  pain  and  disease  if  ordinary  care  was  exercised 
during  the  stay  at  the  place  of  resort.  In  the  crowded  and 
heated  rooms,  excited  by  the  congenial  companionship  of 
friends  and  the  exhilaratory  influences  of  the  general  good 
humor  and  conviviality,  the  system  becomes  a  bonfire  to  the 
emotional  excitement  and  pleasures.  The  heart  beats  fast 
and  faster  and  the  blood  is  driven  with  increased  rapidity 


ESSAYS  AND  A  DhllESSICS.  217 

tlirougli  the  disteiiflod  vgbsoIh.  'V\\i\  wliuN;  .surfare  vaHciilar 
area  is  flushed  vvilli  liol.  blood.  TIiiih  ovorhcated,  and  |t<r- 
ha|)H  to  rest  from  an  anitnatcd  (•()nv(!rHatioii  or  a  danre,  with 
a  glowin<^  and  moistened  Hurfacc,  the  j)eriplioral  vascular  sys- 
tem overfilled  with  hot  blood,  and  a  radiatinfif  area  equal  to 
the  entire  surface,  the  unj)roteetcd  body  is  suddenly  exposed 
to  a  draught  blowing  through  an  open  window  or  door,  or 
to  the  colder  air  of  the  hall,  or  even  to  the  open  atmosphere, 
and  the  vast  volume  of  overheated  blood  is  rapidly  ehilled 
and  driven  back  to  the  interior.  Surface-heat  is  lost  too  rap- 
idly, and  the  cooled  blood,  sent  back  to  the  overheated  organs 
and  tissues,  absorbs  their  heat  too  rapidly.  The  bonfire  is 
extinguished,  but  the  embers  smoulder  in  angry  recognition 
of  the  wilful  or  thoughtless  disregard  of  nature's  plainest  pre- 
cepts. Why  v/onder,  then,  that  colds,  coughs,  neuralgise, 
catarrhs,  digestive  disturbances,  pains,  aches,  or  some  more 
serious  disorder,  should  torment  the  devotee  of  arbitrary 
fashion  and  custom  ?  And  is  it  any  less  surprising  that  the 
sufferer  should  ascribe  to  nature  and  nature's  methods  the 
cause  ?  The  river-flats  lie  in  broad  expanse  along  the  water- 
front, and  marsh-miasmata  offer  a  convenient  and  plausible 
excuse  to  cover  and  hide  one's  own  derelictions. 

Men  are  quite  as  often  guilty  of  even  more  flagrant  abuses 
of  their  constitutions,  not  only  by  excessive  excitement  of 
purely  physiological  functions  and  processes,  but  by  artificial 
stimulation  of  the  nervous  and  vascular  systems.  Alcohol  is 
one  of  the  most  diffusible  and  powerful  of  the  heart-stimu- 
lants. It  accelerates  the  movement  of  that  organ  and  in- 
creases the  frequency  of  the  pulse.  By  this  increased  action 
the  blood  is  driven  with  greater  rapidity  through  the  vessels. 
The  rapid  flow  of  the  alcoholized  blood  to  the  heat- regulating 
centres  increases  heat-production,  and  the  temperature  of  the 
body  is  elevated.  The  surface-area  of  radiation  is  increased 
by  the  greater  quantity  of  blood  flowing  into  and  through  the 
distended  capillary  system.  The  surface-vessels  are  flooded 
with  overheated  and  poisoned  blood.    "When  to  this  condition 


218  ESSAYS  AND  ADDRESSES 

is  added-  the  influence  of  unusual  exercise  the  ill  effect  is  aug;- 
mented.  With  a  greatly  increased  quantity  of  blood  in  a 
greatly  increased  surface-area  exposed  to  a  colder  medium 
heat-loss  is  vastly  augmented,  and  chilling  is  much  more 
rapid  and  effective.  Such  a  condition  may  be  produced  by 
a  single  drink,  and  certainly  will  be  by  frequent  potations  of 
alcoholic  beverages.  Alcohol  also  poisons  the  intelligence. 
The  first  sense  of  satisfaction  and  beatitude  is  quickly  fol- 
lowed by  intellectual  excitation  and  hyperideation,  which  is 
characterized  by  lack  of  moderation,  impaired  judgment,  and 
loss  of  will.  To  these  excitant  stages  others  succeed,  with 
which  too  many  men  are  personally  so  familiar  that  mention 
is  unnecessary  beyond  the  statement  that  a  drunken  person 
loses  heat  faster,  and  will  freeze  sooner,  than  a  sober  one. 
Alcoholism  promotes  the  catching  of  cold.  The  combination 
of  poisoned  intellect,  poisoned  heat-regulating  centres,  stimu- 
lated circulation,  poisoned  blood,  and  a  dilated  and  overfilled 
cutaneous  vascular  system,  promotes,  facilitates,  and  augments 
the  chilling  influences.  It  is  most  frequently  and  far  too  often 
illustrated  in  the  daily  life  of  some  men,  and  but  few  are  will- 
ing to  acknowledge  that  either  the  trivial  or  graver  ailments 
before  referred  to  ever  originate  in  the  pleasures  of  the  cup, 
but  ascribe  their  cause  to  the  emanations  from  the  river-flats, 
and  base  their  prevention  and  cure  upon  the  antidotal  prop- 
erties of  alcohol.  Every  bummer  in  the  city  and  every  vic- 
tim of  chronic  alcoholism  claims  to  be  a  sufferer  from  chronic 
malarial  poisoning,  and  it  is  no  unusual  circumstance  to  see  a 
group  of  them  sunning  themselves  during  the  ague  stage  in 
front  of  some  saloon.  But  others  beside  professional  bum- 
mers delude  themselves  by  this  ratiocination.  The  habitual 
'^  diner-out"  attributes  to  malaria  the  deluge  of  ideation  and 
nightmares,  and  the  lightning-flashes  of  pain  which  disturb 
his  rest  and  make  night  hideous,  and  hurls  with  measured  de- 
liberation the  usual  anathemas  against  a  climate  which  will  not 
permit  rest  at  ease  and  refreshing  sleep  with  a  stomach  over- 
loaded with  the  good  things  of  life  and  the  blood  saturated 


J'JSSAYS  AND  ADDRESSES.  219 

with  the  choicest  wiiuiH,  Th(!  hi^^h  liv<T  and  ovorffd  man 
ascribes  his  stomachic  troubles,  aching  and  dizzy  head, 
confused  mind,  lanj^iior  and  diHinolinatioti  to  (!xerciw,  de- 
pressed spirits,  and  irritable  temper  which  make  all  about 
him  unhappy  and  himself  the  most  miserable  of  all,  to  bil- 
iousness of  miasmatic  origin,  and  cites  with  intemperate; 
vehemence  the  salutary  effect  of  a  half-dozen  after-dinner 
pills  and  the  routine  doses  of  quinine ;  but  he  loses  sight  of 
the  benefit  derived  from  the  rest  and  abstemious  diet  which 
an  injured  and  overworked  stomach  can  secure  only  through 
much  travail  and  many  tribulations.  To  illustrate  the  fre- 
quency of  alleged  malarial  infection  as  the  cause  of  sickness 
which  shouki  be  attributed  to  vices  of  diet,  habits,  imprudent 
exposures,  or  some  one  or  more  of  a  great  variety  of  excesses, 
I  will  briefly  refer  to  the  cases  of  four  gentlemen  from  dis- 
tant and  different  parts  of  the  country,  winter  sojourners 
here  for  the  first  time,  who  were  accustomed  to  the  simple 
habits  of  prudent  people  at  home,  unused  to  late  hours,  and 
strangers  to  terrapin-suppers  and  the  usual  accompaniments. 
One  has  lived  many  years  in  the  valley  of  the  Wabash, 
another  near  swamps  in  the  Carolinas,  a  third  is  from  pious 
New  England,  where  malaria  was  unknown  until  the  Rebel- 
lion came,  and  the  fourth  has  passed  the  life  of  a  cosmopol- 
itan and  has  seen  malaria  so  dense  that  it  could  be  sliced  into 
blocks.  All  have,  many  times,  had  old-fashioned  fever  and 
ague,  with  chills  which  shook  their  joints  loose  and  made 
their  hair  stand  on  end  ;  but  neither  had  ever  before  lived  in 
a  climate  where  malaria  followed  people  in  fierce  pursuit  at 
every  turn  during  the  day,  howled  under  the  eaves  at  night, 
stole  through  the  stomach,  and  sneaked  in  under  the  nether 
garments.  They  are  gentlemen  of  elegant  leisure,  equipped 
with  ample  means  and  a  generous  hospitality,  and  are  here 
for  pleasure  and  intellectual  recreation,  and  to  teach  the  good 
people  how  best  to  make  life's  cares  pass  swiftly  and  merrily. 
They  have,  week  after  week,  gone  the  round  of  dinnere,  high 
teas  and  suppers,  of  card-parties,  theatre-parties,  and  aesthetic 


220  ESSAYS  AND  ADDRESSES. 

reimions;  and  wasted  their  uuoceupied  leisure,  when  other 
people  are  toiling,  in  busy  preparation  for  the  succeeding 
entertainment — one  by  drenching  himself  with  mineral  waters 
to  tone  up  his  stomach,  another  to  clear  his  head,  a  third  by 
squeezing  his  liver  with  some  popular  nostrum,  and  the  fourth 
slumbered  under  the  o-asliffht  that  the  sunshine  misi-ht  not  dis- 
turb  his  reveries  in  dreamland.  This  contest  of  pleasure  and 
excess  against  physiological  endurance  has,  as  is  usual,  added 
four  to  the  list  of  the  vanquished,  and,  notwithstanding  the 
antidotal  drink  and  dose  of  quinine,  each  ascribes  his  present 
condition  to  the  horrid  atmosphere  which  custom  and  habit 
allege  is  saturated  with  malarial  emanations  from  the  river- 
flats,  even  during  the  season  of  the  year  when  the  tempera- 
ture is  far  below  the  point  necessary  for  the  generation  of 
miasmata.  N^either  will  accept  the  suggestion  that  the  blood 
alcoholized  and  overheated,  the  stomach  overladen  with  food 
and  viands,  or  the  nervous  system  overstrained  by  artificial 
stimulation,  bears  even  a  causal  relation  to  the  ills  which  so 
sorely  afflict  them.  And  so  thoroughly  are  they  imbued  with 
the  popular  and  erroneous  belief  that  either  would  rather  go 
to  the  grave  through  years  of  wretched  suffering,  penury,  and 
want,  or  the  mad-house,  than  have  health  upon  the  basis  of 
an  abstemious  and  prudent  life. 

It  is  not  probable  that  the  abuses  of  human  life  will  ever 
cease,  or  that  the  defective  construction  of  human  habitations 
will  ever  be  wholly  prevented,  or  that  the  unsanitary  condi- 
tioxis  of  cities  will  ever  be  completely  cured.  Nor  is  there 
any  natural  requirement  of  life  that  necessarily  entails  dis- 
ease, yet  few  of  those  born  die  by  natural  decay.  To  the 
avoidable  causes  of  disease  far  the  larger  number  of  deaths 
are  due.  It  is  only  by  the  education  of  the  masses  in  the 
methods  of  prevention  that  the  science  of  medicine  can  attain 
its  proper  position  and  influence  among  mankind. 


ESS  A  YS  A  ND  A  D  DRESSES.  221 


WASHINGTON     OBSTI^7rRI-CAL    AND    GYNECO- 
LOGICAL  SOCIETY. 

FIRST   ANNUAL,    ADDRIOSH    OF    THE    PRESIDENT,    I>ErJVi:iiED 
BEFORE  THE  WASHINGTON  OBSTETRICAL  AND  GYNE- 
COLOGICAL  SOCIETY,  OCTOBER  5,  1883. 


CRANIOTOMY  UPON  THE  LIVING  FCETUS  IS  NOT  JUSTIFIABLE. 

Gentlemen  :  The  meeting  to-night  completes  the  first 
year  of  the  existence  of  this  Society,  and  it  gives  me  pleasure 
to  congratulate  you  upon  the  success  attained. 

The  duties  of  the  presiding  officer  have  been  exceedingly 
light  and  pleasant.  During  the  entire  session  there  has  not 
occurred  a  single  infraction  of  the  rules  and  courtesies  of  de- 
portment, or  of  parliamentary  order  or  decorum,  and  there 
has  been  but  one  failure  to  comply  with  the  individual  obli- 
gations of  the  members.  The  attendance  has  been  prompt 
and  the  average  unusually  large. 

The  essays  and  discussions  have  exhibited  study,  thought, 
and  a  high  order  of  professional  and  scientific  attainment. 
There  has  not  been  one  indifferent  paper  submitted.  The 
zeal  and  enthusiasm  displayed  by  the  essayists  should  com- 
mand the  admiration  of  the  entire  membership,  and  every 
member  must  acknowledge  the  value  of  the  instruction  de- 
rived from  the  efforts  of  his  colaborers  in  this  field  of  obstet- 
ric, gynecic,  and  poediatric  study. 

This  young  and  vigorous  Society  has  not,  however,  been 
permitted  to  complete  its  first  year's  existence  without  a  sor- 
row. The  memory  of  the  lamented  Ashford  lingers  in  the 
freshness  of  commingled  affection  and  grief.  We  who  knew 
him  so  well,  who  had  learned  to  value  the  qualities  of  his 
heart  and  mind,  and  had  so  often  listened  to  his  terse  and 


222  ESSAYS  AND  ADDRESSES. 

cogent  utterances,  will  not  soon  forget  our  friend,  companion, 
counsellor,  and  coworker.  He  died  at  the  early  age  of  forty- 
two,  yet  had  made  for  himself  a  reputation  which  but  few 
can  hope  to  attain,  and  he  has  left  to  his  friends  and  family 
the  heritage  of  an  untarnished  name  and  spotless  character. 

Medical  societies  with  limited  memberships,  for  the  mutual 
instruction  of  their  members  in  special  departments  of  the 
science  of  medicine,  have  become  quite  common  in  the  larger 
cities,  both  abroad  and  at  home.  Societies  similar  to  our  own 
have  been  established  during  the  last  decade  in  many  cities  no 
larger  than  Washington.  The  time  has  surely  come  when  it 
is  the  duty  of  those  who  are  especially  interested  in  the  study 
and  practice  of  obstetrics  and  the  diseases  of  women  and  chil- 
dren to  unite  and  concentrate  their  individual  efforts  for  their 
common  good.  The  results  in  other  places  have  demonstrated 
the  literary  and  scientific  advantages  of  similar  organizations, 
and  it  cannot  be  doubted  that  this  city  possesses  professional 
talent  which  will  cope  with  the  highest  order  of  medical  intel- 
lect. This  position  cannot,  however,  be  won  if  individual 
capacities  and  acquirements  are  confined  to  the  privacy  and 
isolation  of  the  sick-room.  Enlarged  thought  and  advanced 
study  demand  the  broader  field  of  intellectual  comparison, 
analysis,  and  trituration.  These  desiderata  can  only  be  se- 
cured by  organized  effort,  systematic  presentation  of  well- 
considered  opinions,  clinical  experience  and  observation,  and 
the  examination  and  discussion  of  these  by  men  engaged  in 
the  same  field  of  scientific  labor.  The  success  of  the  past 
year  gives  assurance  of  the  complete  fulfilment  of  the  para- 
mount objects  of  the  Association.  The  first  being  mutual 
improvement  in  scientific  knowledge  and  practical  skill,  and 
the  second  a  more  intimate  mutual  acquaintance  and  personal 
intercourse. 

A  careful  record  of  the  proceedings  and  the  publication  of 
its  transactions  constitute  the  chief  incentives  to  intelligent, 
systematic,  and  persistent  work.  No  medical  society  pros- 
pers long  and  continuously  without  these  aids.     Upon  the 


ESS  A  YS  AND  ADDRESSES.  22'^ 

recording  secretary  and  (committee  of  ])iil>lifiit.ioii  iinj)«>rturit 
duties  are  devolvcul,  to  the  complete  and  impartial  dineliarge 
of  wliicli  the  (H)iiliini('(l  cxiHtiMHU!  and  hii(;c(;sh  of  this  Society 
mainly  depend.  'J'hc  <;oiMniittee  Hhonld  he  clothed  wifh  full 
and  necessary  powers,  and  the  Society  should  hold  it  to  a 
strict  responaihility.  TIk;  duties,  though  very  onerous,  are 
too  important  to  he  neglected,  and  the  cotnniittee  should  feel 
that  the  life,  usefulness,  and  standing  of  the  Society  will  be 
the  measure  of  a  earefid  and  exact  observance  of  its  duty. 

It  would  be  invidious  in  me  to  select  any  one  of  the  papers 
read  before  this  Society  for  special  commendation  or  criticism. 
It  will,  however,  be  pardonable  to  recall  your  attention  to  a 
subject  which,  in  somewhat  different  aspects,  was  discussed 
on  several  occasions. 

I  am  induced  to  refer  again  to  the  justifiability  of  the 
operation  of  craniotomy  upon  the  living  foetus  because  of  the 
great  importance  of  the  subject  and  the  increasing  interest 
which  it  is  now  exciting,  hoping  that  with  the  re-examina- 
tion now  in  progress  there  will  result  a  modification  of  the 
extreme  views  which  have  been  held  by  a  large  majority  of 
the  ablest  and  most  renowned  obstetricians  of  the  past,  and, 
perhaps,  of  those  living  of  equal  ability. 

IS    CEANIOTOMY    UPON    THE    LIVING    FCETCS  A  JUSTIFIABLE 
OPERATION  ? 

It  is,  probably,  the  most  ancient  of  obstetric  operations,  and 
the  hook  and  perforator  are,  perhaps,  the  most  antique  of  ob- 
stetric instruments.  The  operation  means  death  and  mutila- 
tion of  the  foetus,  and  is  performed  solely  in  the  interest  of 
the  mother.  When  the  foetus  is  already  dead  it  is  an  accepted 
procedure,  within  certain  Avell-defined  limits,  to  effect  delivery; 
but  then,  as  well  as  when  the  foetus  is  living,  it  demands  skill 
and  dexterity.  In  a  large  percentage  of  cases  it  is  attended 
with  serious  dangers  to  the  woman,  and,  according  to  Churchill 
and  Tyler  Smith,  with  a  mortality  in  the  proportion  of  one  to 


224  ESSAYS  AND  ADDRESSES. 

five.  jNIany  other  authors  claim  a  higher  death-rate,  and  a 
few  a  lower  one.  When  performed  upon  the  living  foetus  it 
necessarily  involves  the  deliberate  killing  aud  mutilation  of  a 
human  being.  In  every  case  of  labor  two  lives  are  more  or 
less  in  danger.  Fortunately,  in  a  vast  majority  of  cases,  both 
lives  are  conducted  safely  through  and  past  the  perils  of  par- 
turition. For  the  comparatively  few  cases  in  which  delivery 
cannot  be  accomplished  without  artificial  aid  the  operation 
of  craniotomy  was  originally  devised  in  the  interest  of  the 
mother,  and  from  the  times  of  Hippocrates  and  Celsus  it  has 
been  recognized  as  a  justifiable  procedure,  even  when  the 
foetus  was  alive. 

In  the  remote  periods  of  antiquity  many  pregnant  women 
must  have  perished  in  the  travail  of  labor,  undelivered ;  but 
even  after  the  invention  of  the  hook  and  perforator,  and 
through  all  subsequent  time  down  to  the  present,  with  the 
progressive  improvements  in  instruments,  advances  in  obstet- 
ric knowledge  and  science,  and  the  acquisition  of  manual  dex- 
terity, no  operator  has  ever  yet  assured  the  life  of  the  mother, 
even  after  the  life  of  the  foetus  had  been  sacrificed,  and  the 
best  result  that  can  be  offered  is,  according  to  the  standard^ 
of  Churchill  and  Smith,  the  saving  of  the  lives  of  four  mothers 
out  of  five,  or,  in  other  words,  the  saving  of  four  lives  out  of 
ten  imperilled. 

In  the  earlier  times,  when  obstetric  operations  had  their 
beginning  and  were  at  best  performed  with  rude  appliances 
in  a  bungling  and  unscientific  manner  by  operators  lacking 
knowledge  and  experience,  the  preservation  of  four  lives  out 
of  ten  which  would  certainly  have  perished  must  be  cherished 
as  a  blessing  to  humanity,  and  the  means  by  which  it  was 
accomplished  must  be  regarded  as  a  great  advance  in  the 
obstetric  art.  But  as  yet  there  is  no  proof  that  Hippocrates, 
Celsus,  or  the  Arabian  physicians  ever  deliberately  destroyed 

1  In  view  of  the  advantages  of  antiseptics  in  surgical  operations,  this  standard  may- 
be unfavorable  to  craniotomy,  but  as  the  object  is  to  illustrate  the  fact  that  it  is 
attended  with  a  mortahty,  not  now  possible  to  ascertain,  it  answers  the  purpose. 


EfiSA  YS  A  Nl>  A  DDIIESSKS.  225 

the  lil"(!  of  the  f(ijtu9  preliiiiiiuiry  (o  the  extr;icti(jii  of  tlie  Hiuti- 
lated  body  of  the  unborn  child.  Jt  may  be  that  their  mor- 
tahty  of  niothei'fl  was  greater,  pcirhapH  far  greater,  than  it  is 
to-day;  but  when  IJandeloeqne  and  Kliige  rat^d  it  at  more 
than  50  per  eentum,  Rolvitanski  at  41,  and  Ilfsmming,  Jones, 
Churchill,  and  Smith  at  20,  the  comparison  of  our  later- 
known  results  with  tiie  unknown  of  the  remote  past  does  not 
(!ondu(!e  to  a  very  high  appreciation  of  the  progressive  im- 
]irovemcnt  in  the  operation  of  craniotomy.  If,  however,  the 
question  of  mortality  be  studied  chronologically,  it  will  aiv 
pear  that  the  death-rate  of  mothers  has  diminished  with  the 
lapse  of  time  and  advance  of  obstetric  science,  and  that  it  is 
now  less  than  at  any  former  period.  It  must,  nevertheless, 
be  admitted  that  while  the  mortality  of  mothers  has  been 
diminished  by  the  more  dexterous  performance  of  the  opera- 
tion and  the  better  management  of  the  cases,  the  relative  pro- 
portion of  foeticides  has  greatly  increased,  and  the  sum  total 
of  lives  lost  and  sacrificed  has  been  greater  during  the  present 
than  during  any  previous  century  since  the  operation  was  de- 
vised. The  more  frequently  the  operation  is  performed  on 
the  living  foetus  the  greater  the  number  destroyed,  for  half 
of  the  lives  imperilled  must  necessarily  be  sacrificed,  and  the 
chances  of  saving  the  remaining  half  can  only  be  enhanced 
by  a  percentage  equal  to  the  death-rate  of  the  mothers,  what- 
ever that  may  be.  The  most  expert  and  experienced  operator 
cannot  save  more  than  half  the  lives  at  risk,  and  the  more 
dexterous  the  greater  the  number  of  ventures,  consequently 
the  greater  the  loss  and  sacrifice  of  life.  Xo  one  has  or  can 
hope  to  attain  the  success  of  saving  a  possible  50  per  centum 
of  the  lives  at  stake. 

Just  here  I  will  be  confronted  with  the  statement  of  those 
who  have  performed  one,  two,  three,  four,  or  five  cranioto- 
mies without  the  death  of  a  mother.  The  assertion  of  such 
a  fact  is  probable  proof  that  the  operations  were  hasty  and 
unnecessary.  The  successful  crauiotomist,  more  often  influ- 
enced by  ambition  than  judgment,  and  dazzled  by  the  desire 

15 


226  ESSAYS  AND  ADDRESSES. 

to  gain  an  additional  success,  precipitates  the  death  of  the 
foetus  that  the  dangers  of  delay  may  be  avoided.  If  it  is 
justifiable  during  the  lifetime  of  the  foetus,  it  is  best  to  pro- 
ceed to  its  execution  before  the  exhaustion  of  the  patient  by 
ineffectual  efforts,  and  before  the  contusion  of  the  soft  parts 
incident  to  attempts  to  effect  delivery  by  the  more  conserva- 
tive intrapelvic  methods.  But  if  such  a  rule  should  become 
the  established  practice,  it  is  only  the  exceptional  few  who 
can  avoid  the  guilty  killing  of  a  human  being  in  cases  where 
delivery  of  a  living  child  might  have  been  accomplished  per 
vias  naturales.  Even  so  distinguished  an  obstetrician  as  Al- 
bert Smith^  relates  a  case  where  a  living  child  was  born  while 
a  messenger  had  gone  for  the  instruments  of  death,  and 
more  than  once  the  shocking  illustration  of  bungling  haste 
has  been  exhibited  in  the  cries  of  a  mangled  infant. 

Craniotomy  offers  no  hope,  not  even  a  ray  of  the  promised 
life  to  the  unborn;  but  proclaims  from  the  altar  of  profes- 
sional justification  death  by  violence  to  the  foetuses  of  women 
who  are  physically  incapacitated  to  give  birth  to  a  living 
child.  Nay,  more,  it  offers  immunity  from  the  travail  of 
labor,  and  protection  from  the  annoyances  of  maternity  to 
those  who  have  accepted  the  pleasures  of  concubinage  or  wed- 
lock, and  have  become  co-partners  in  the  creation  of  a  new 
being  and  a  new  soul  to  live  forever,  but  who  cannot  com- 
plete the  highest  and  noblest  purpose  of  woman's  creation. 
So  repulsive  does  it  present  itself  in  this  aspect  that  many 
who  have  advocated  and  performed  it  recoil  from  its  repeti- 
tion upon  the  same  woman.  The  renowned  Meigs,^  who 
had  twice  successfully  delivered  Mrs.  Reybold,  refused  to 
incur  the  responsibility  of  a  third  operation  ;  Gibson  subse- 
quently twice  delivered  her  by  Csesarean  section  of  a  living 
child,  and  she  lives  to-day  in  the  ripeness  of  a  happy  old 
age  in  the  enjoyment  of  two  children  and  six  grandchildren.^ 

1  Medical  Times,  March  10, 1883,  p.  412.  -  Prof.  Charles  D.  Meigs. 

3  Several  of  the  subjects  of  Cfesarean  delivery  have  reached  advanced  life  in  the 
United  States,  the  oldest  known  being  sixty-eight  and  seventy-four  years  respectively. 


RSSAYS  AND  A  DhRESHES.  227 

Witli  siKtli  a  Hliowin;^  it  imiHt  follow  tliut  tlic  operation  is 
deteHtal)l(!  where  a  liviiij^  child  is  at  stake.'  If  ho,  is  it  entitled 
to  a  plaee  anionj^  the  scientific  surgical  procedures  of  the 
present  time?  Does  the  fact  that  in  a  limited  number  of 
those  eases  where  tlu;  mother's  life  only  is  in  peril,  an  early 
and  skilful  pcM'formauce  secures  a  reasonable  prospect  of 
recovery,  give  it  such  a  place  ?  Must  this  one  fact,  the  only 
one  in  justification,  and  always  embarrassed  by  the  ])roba- 
bility  of  repetition,  and  tlu;  consequent  variations  in  the 
chances  of  success,  counterbalance  the  enormity  of  deliber- 
ately taking  the  life  of  the  unborn?  To  admit  this  in  the 
fuhiess  of  its  import  is  to  concede  that  intra-uterine  life  forms 
no  part  of  the  heritage  of  human  existence,  and  that  the  vio- 
lent destruction  of  a  new  being  just  at  the  moment  when 
nature  has  completed  the  processes  which  fit  it  for  an  inde- 
pendent life  is  a  matter  of  such  trivial  concern  that  it  can  be 
deterrained  upon  the  probabilities  of  enhancing  the  prospects 
of  the  woman's  recovery. 

If  craniotomy  is  justifiable,  science  and  the  good  of  man- 
kind demand  that  the  limits  of  its  application  should  be  defi- 
nitely fixed.  This  question  is  now  engrossing  the  attention 
of  some  of  the  ablest  and  most  conscientious  members  of  the 
profession.  It  cannot  be  disposed  of  by  words  or  sentiment, 
but  must  be  settled  by  an  examination  of  the  facts  derived 
from  an  intelligent  experience  and  an  impartial  study  of  the 
complications  of  labor  and  the  methods  of  relief. 

It  matters  not  whether  craniotomy  is  or  is  not  the  most 
ancient  of  obstetric  operations;  in  a  scientific  aspect  all  the 
other  methods  and  procedures  which  have  for  their  purpose 
the  saving  of  the  lives  of  both  the  mother  and  child  must  be 
regarded  as  its  substitutes.  These  may  be  divided  into  iutra- 
aud  extra-pelvic.  Under  the  first  must  be  classed  delivery 
by    the   forceps,    by  turning,    the    induction    of    premature 

Several  of  the  children  have  been  heads  of  families,  and  one  in  this  city  [Philadelphia] 
is  now  forty-eight  years  old,  and  has  given  birth  to  eight  children,  three  of  •whom 
have  grown  up.— Medical  Xews,  October  13, 1SS3,  p.  411. 


228  ESSAYS  AND  ADDRESSES. 

labor,  and  symphysiotomy;  under  the  latter,  the  Caesareau 
section  and  its  substitutes,  laparo-elytrotomy,  the  utero- 
ovarian  amputation,  and  the  total  extirpation  of  the  uterus, 
in  all  eight.  The  mere  enumeration  of  this  number  of 
obstetric  devices,  and  the  constant  and  persistent  efforts  to 
improve  and  popularize  them,  constitute  a  reasonable  pre- 
sumption of  a  widespread  detestation  of  craniotomy  ;  and  the 
present  revival  of  interest  in  and  discussion  of  the  relative 
merits  of  the  extra-pelvic  methods,  and  their  advantages  over 
craniotomy,  would  seem  to  be  conclusive  against  its  continued 
acceptance  as  a  scientific  procedure,  and  relegate  it  to  the  class 
of  desperate  expedients,  of  doubtful  propriety  under  any 
circumstances. 

According  to  Tyler  Smith,  about  half  of  the  cases  of  crani- 
otomy are  occasioned  by  contraction  of  the  pelvis.  This  esti- 
mate is  too  low.  The  great  improvement  in  the  forceps,  and 
greater  dexterity  acquired  in  the  execution  of  the  intra-pelvic 
substitutes,  have  vastly  lessened  the  field  of  application  for- 
merly claimed  for  it,  other  than  in  cases  of  pelvic  deformity. 
This,  I  believe,  is  now  univerally  conceded  by  competent 
authority.  And,  even  in  very  many  cases  of  faulty  pelvis, 
to  which,  until  recently,  it  was  applicable,  the  better  results 
to  mothers  now  obtained  by  other  methods  have  entirely 
excluded  it. 

In  the  justo-minor  or  equally  contracted  pelvis  it  is  inad- 
missible. In  support  of  this  statement  I  need  only  quote  two 
recent  authors.  Lusk,  in  1879,  reported^  a  case  in  which 
the  conjugate  diameter  measured,  in  the  dried  specimen,  three 
and  one-sixth  inches  ;  craniotomy  proved  fatal.  In  his  review 
of  the  subject  he  could  find  but  five  recorded  cases  of  '^  gen- 
erally contracted  pelves,  in  which  the  conjugate  ranged  from 
three  to  three  and  a  quarter  inches,  and  all  died  as  a  conse- 
quence of  delivery  through  the  natural  passages."  In  the 
same  paper  he  refers  to  the  case  of  Korman,  nearly  identical 

1  Gynecological  Transactions,  vol.  iv.  p.  358. 


ESSAYS  AN/)  Ai>nf!.i':ssi<:s.  22f> 

with  liiH  own,  in  vvliicli,  "  after  nion;  than  i,\ir<-<-  dayK'  laijor, 
the  head  adapted  itself  to  the  pelvis,  and  the  ehild  was  deliv- 
ered alive  by  forceps.  The  mother  died  of  peritonitis."  Even 
in  eases  of  sncli  extreme  <2:eneral  contraetion  natnre  and  the 
timely  applic^ation  of  th(!  forceps  have  yielded  better  results 
than  craniotomy.  In  discussing  the  proper  management  of 
such  cases  he  says  that  laparo-elytrotomy,  whifih  had  been 
recently  revived  by  the  ''genius  of  Thomas  and  the  daring 
of  Skene,"  is  peculiarly  fitted  to  such  conditions,  and  con- 
cludes with  the  assertion  that,  after  a  earefnl  study,  he  is 
convinced  that  "  where  there  is  a  diminution  of  nearly  an 
inch  in  all  the  diameters,  Csesarean  section  or  probably 
laparo-elytrotomy  holds  out  the  best  chances  of  success." 

Professor  Isaac  E.  Taylor,  in  a  masterly  paper  on  the 
equally  faulty  or  justo-minor  pelvis,  recently  published,^ 
asserts  that  ''  in  almost  all  the  cases  recorded  of  equally 
faulty  or  contracted  pelvis,  when  the  diminution  is  from 
three-fourths  to  one  inch,  both  mother  and  child  are  lost." 
In  considering  the  treatment  he  declares,  with  marked  em- 
phasis, that  the  loss  of  lives  of  mothers  by  craniotomy  and 
cephalotripsy  in  such  cases,  when  the  diminution  is  from 
three-fourths  to  one  inch  (and  the  total  loss  of  life  to  the 
child,  even  iu  the  minor  degree  of  lessening  of  from  one- 
third  to  one-half  inch),  is  so  disastrous  that  a  conscientious 
discharge  of  duty  demands  the  substitution  of  Caesarean  sec- 
tion or  some  of  its  modifications,  or  symphysiotomy  even  in 
the  minor  degree  of  one-lialf  inch.  In  the  higher  grades  of 
contraction  a  more  appalling  presentation  than  by  either  of 
these  operations  could  not  exist.  In  the  justo-minor  pelves 
craniotomy  is  inadmissible. 

The  most  common  form  of  deformed  pelves  is  the  simple 
flat,  rickety  or  non-rickety,  in  which  the  faulty  condition  is 
mainly  in  the  conjugate  diameter ;  hence  it  is  usual  to  discuss 
the  relative  applicability  of  the  various  methods  of  treatment 

1  .^jnerican  Journal  of  Obstetrics,  August,  18S3,  p.  Sll. 


230  ESSAYS  AND  ADDRESSES. 

with  special  reference  to  the  measurements  of  the  conjugate. 
There  is  not,  perhaps,  living  to-day  a  single  obstetric  authority 
of  accepted  repute  who  will  claim  the  practicability  of  crani- 
otomy in  cases  where  the  conjugate  is  one  and  a  half  inches 
or  less.  Indeed,  but  few  hold  it  justifiable  when  the  conju- 
gate is  two  and  one-half  inches  or  less.  Parry,  as  early  as 
1878,^  demonstrated  that  in  pelves  with  a  conjugate  of  two 
and  one-half  inches  or  less,  craniotomy  gave  no  better  results 
to  mothers  than  Csesarean  section.  When  the  total  number 
of  lives  at  stake  is  considered,  the  results  are  vastly  less  favor- 
able than  from  Cresarean  section,  even  when  performed  under 
disadvantageous  conditions,  for  one-half  of  the  lives  are  cer- 
tainly sacrificed  by  the  murderous  operation,  and  in  those 
pelves  where  the  conjugate  is  less  than  two  and  one-half 
inches  Csesarean  section  is  preferable  whether  the  foetus  is 
dead  or  alive.  "  As  much  as  I  have  advocated,"  says  Tay- 
lor, "  craniotomy  in  preference  to  Csesarean  section,  in  simple 
flat  pelves,  in  my  former  papers  on  craniotomy  and  cephalo- 
tripsy,  I  am  constrained  to  believe  that  one  of  the  external 
operations,  as  the  Csesarean  section,  or  laparo-elytrotomy, 
early  performed,  or  symphysiotomy  when  the  labor  is  more 
advanced  and  the  head  wedged  in  the  cavity,  should  be 
selected."  In  fact,  in  the  light  of  recent  experience  and  the 
improved  results  obtained  from  the  intra-  and  extra-pelvic 
substitutes,  professional  opinion  seems  to  be  rapidly  ap- 
proaching the  definite  conclusion  that,  when  the  conjugate 
is  less  than  two  and  one-half  or  two  and  five-eighths  inches, 
craniotomy  is  absolutely  inadmissible. 

''As  we  have,"  says  Montgomery,  in  a  very  able  paper 
read  before  the  Philadelphia  County  Medical  Society,^  "but 
three-fourths  of  an  inch  between  three  and  twenty-five-hun- 
dredth s  inches,  the  maximum  diameter  at  which  craniotomy 
is  supposed  to  be  necessary,  and  two  and  one-half  inches,  the 
minimum  diameter,  in  which  it  is  safer  for  the  mother  than 

1  American  Journal  of  the  Medical  Science,  1878,  vol.  Ixxiv.  p.  323. 

2  E.  E.  Montgomery  :  Medical  Times,  March  10, 1883,  p.  387. 


ESS  A  YS  A  NT)  A  T)  DRESSES.  231 

Crcsarcan  Koction,  w(!  Ii.'ivo  cortainly  rc'iclicd  :i  pftiofl  wlicn 
W(i  an;  jiis(i(ic<l  in  jilK)lisliiii<^  IIk;  iniirdcivniH  opcrution  of 
cruniotoiiiy  from  the  list  of  clcictivc;  o|t(:rntiori.s  wlu-n  the 
foetus  i.s  .still  alive."  In  the  same  paper,  with  efjiial  aljility 
and  fairness,  he  discusses  the  relative  advantages  and  merits 
of  other  alternatives,  and  reaches  the  follf)wing  conclusions, 
which  1  accept  in  their  entirety.  Tliese  methods  are  equally 
safe  to  the  mother,  and  afford  the  child  a  chance  for  life. 
They  are  suggested  in  the  following  order:  Where  the  con- 
jugate measures  three  and  one-fourth  inches  or  over,  the  for- 
ceps; two  and  three- fourths  inches  or  over,  version  ;  two  and 
three-eighths  inches  or  over,  symphysiotomy,  followed,  if 
necessary,  by  the  forceps.  In  all  subsequent  pregnancies, 
and  in  the  first  when  distortion  is  discovered  sufficiently 
early,  premature  labor  should  be  induced. 

I  need  not  pause  to  portray  the  value  of  the  forceps.  Per- 
haps no  other  instrument  ever  invented  has  contributed  as 
much  toward  the  alleviation  of  suffering  and  saved  so  many 
lives.  It  is  almost  universally  recognized  as  both  a  mother's 
and  a  child's  instrument,  and  it  is  a  significant  fact  that  those 
who  most  frequently  use  forceps  have  least  occasion  to  resort 
to  either  of  the  deadly  expedients.  The  danger,  if  any,  is  not 
the  result  of  their  application,  but  of  delay  in  using  them. 

When  the  conjugate  measures  between  three  and  one-fourth 
and  two  and  three-fourths  inches^  version  offers  greater  pros- 
pect of  success  than  craniotomy.  The  mortality  of  version 
has  been  generally  estimated  at  one  in  sixteen  of  mothers  and 
one  in  three  of  children.  This  is  believed  to  be  too  high  ; 
but  whatever  it  may  be,  it  is  in  marked  contrast  to  that  of 
craniotomy,  even  when  the  latter  is  limited  to  like  conditions 
of  pelvic  deformity  or  other  causes  of  obstruction  in  which 
either  is  claimed  to  be  admissible.  The  mortality  in  cases 
of  version  is  not,  however,  due  wholly  to  the  method,  but 
quite  as  often  to  the  causes  which  indicate  it,  as  in  placenta 

1  In  pelves  whose  conjugate  ranges  from  '2.75  to  3.25  inches  turning  shoald  be  the 
initial  step.— Goodell :  American  Journal  of  Obstetrics,  vol.  viii.  p.  215. 


282  ESSAYS  AND  ADDRESSES. 

preevia  and  rupture  of  the  uterus,  wliicli  may  make  it  speedily 
imperative. 

TLie  induction  of  premature  labor  offers  a  more  decided 
antagonism  to  craniotomy,  because  it  is  specially  applicable 
in  those  conditions  of  pelvic  distortion  in  which  the  crani- 
otomist  insist  the  latter  operation  is  the  proper  elective  pro- 
cedure. Its  application  lies  within  the  limit  of  two  and  one- 
half  inches  minimum  and  three  and  one-half  inches  maximum 
measurement  of  the  antero-posterior  diameter.  It  is  conceded 
that  a  viable  child  cannot  be  extracted  through  a  pelvis  with 
a  conjugate  less  than  the  minimum,  and  that  a  living  child  at 
full  term  can  be  delivered  through  the  natural  passages  with 
a  pelvis  measuring  not  less  than  three  and  one-half  inches 
antero-posteriorly.  Ritgen  has  constructed  from  the  various 
measurements  of  the  size  of  the  head  (quoted  from  Montgom- 
ery) at  different  periods  of  utero-gestation  the  following  table 
showing  the  application  of  induced  premature  labor,  after  the 
period  of  viability,  to  various  grades  of  pelvic  deformity.  He 
says  labor  may  be  induced  at  the 

29th  week,  -when  anterior  posterior  diameter  of  pelvis  is  2"     7'" 
30thi    "  "  "  "  "  "  "28 

31st      "  "  "  "  "  "  "29 


35th 
36th 
37th 


2      10 

2  11 

3  0 


From  statistics  of  artificially  induced  premature  labor  in 
cases  of  pelvic  deformity,  which  I  collated  some  years  ago, 
when  studying  the  value  of  the  procedure  in  aggravated 
uraemia,  I  determined  the  maternal  mortality  at  6^^-^  per 
cent.,  and  that  of  children  at  40  per  cent.  In  these  figures 
were  included  a  large  number  of  operations  performed  in  the 
interest  of  the  mother  and  under  conditions  which  necessarily 
sacrificed  the  life  of  the  foetus.  With  the  improvement  in 
the  management  of  such  cases  greater  safety  has  been  secured 
to  mother  and  child. 


1  Kiwisch  says  2>^  inches  conjugate  is  necessary  for  a  viable  foetus  at  30th  week  to 
pass  safely. 


ESS  A  YS  AND  A  I)  I)  It  ICSSHS.  233 

It  tliiiH  a[)[)C'nr.s  tliiit  tlie  induction  of  pr(;nialnr(;  luhur 
covers  the  exact  limits  of  pelvic  obstruction  and  offers  better 
results  than  craniotomy.  It  will,  however,  be  said  that,  as 
a  rule,  it  can  only  a]>|)ly  to  .second  and  subsequent  pregnan- 
cies, because  the  incapacity  will  not  have  been  discovered 
until  labor  has  begun.  This,  unfortunately,  is  too  true  ;  but 
it  is  not  an  argument  against  the  induction  of  premature 
labor  or  in  favor  of  the  practice  of  craniotomy.  It  is  simply 
proof  of  failure  or  neglect  to  ascertain  the  fitness  of  the  preg- 
nant woman  to  give  biith  to  a  living  child  per  vias  naturales 
before  it  is  too  late  to  advise  her,  and  to  adopt  the  means 
science  offers  for  the  better  protection  of  herself  and  her  fjff- 
spring  from  the  dangers  incident  to  her  condition.^ 

I  must  express  my  detestation  and  abhorrence  of  the  wide- 
spreading  vice  of  criminal  abortion.  I  hold  with  that  most 
eminent  man  and  pious  physician,  the  elder  Hodge,  that  con- 
ception brings  into  existence  a  new  being  and  an  immortal 
soul,  and  that  it  is  alike  criminal  in  the  mother  and  in  the 
physician  to  employ  means  to  destroy  that  being  that  sin  and 
shame  may  be  concealed  or  pride  maintained.  No  reputable 
and  conscientious  physician  will  engage  in  or  connive  at  the 
criminal  production  of  abortion.  Does  the  crime  consist  in 
the  performance  of  the  operation,  in  the  effort  to  conceal  vice, 
hide  shame,  prevent  disgrace,  obviate  the  discomforts  of  ma- 
ternity, or  in  the  deliberate  act  of  killing  ?  If  in  the  latter, 
then  tell  me  where  the  obligations  of  professional  duty  cease 
and  crime  begins  ?  To  me  abortion  as  a  substitute  is  equally 
as  reprehensible  as  craniotomy.  It  cannot,  however,  occupy 
a  place  among  the  conservative  methods,  for  in  those  cases  in 
which  pelvic  deformity  will  not  afford  a  chance  to  a  viable 
foetus  craniotomy  is  conceded  to  be  inapplicable. 

The  revival   of   the   invention   of   Sigault,  by  Professors 

1  There  have  been  as  many  as  sixteen  children  sacrificed  in  the  successive  labors 
of  one  lady  in  this  city  [Philadelphia],  each  head  having  been  locked  in  her  pelvis, 
which  was  small  but  not  deformed  ;  a  seventeenth  was  saved,  by  an  accident  induc- 
ing labor,  ^vhen  she  was  eight  months  pregnant.— Harris  :  American  Journal  of  the 
Medical  Sciences,  vol.  Ixxxv.  p.  31. 


234  ESSA  YS  AND  ADDRESSES. 

Morisaiii  aud  Novi  iu  the  Neapolitan  Hospital  for  Incurables 
has  supplied  another  conservative  procedure  which  promises 
most  favorable  results.  Harris^  informs  me  that  in  the  last 
twenty-one  years  seventy-one  operations  have  saved  fifty-thi-ee 
women  and  fifty-five  children.  This  result  "  is  equal  to  that  of 
early  performed  Cesarean  section  under  favorable  circum- 
stances." It  has  been  alleged  that  symphysiotomy,  even  when 
the  pubic  joint  "  was  opened  to  the  extent  of  three  inches,  with- 
out impairing  or  injuring  the  sacro-iliac  joint,  only  three  or 
four  lines  at  most  could  be  gained."  This  is  true  in  regard  to 
the  antero-posterior  diameter  ;  but  the  transverse  and  oblique 
diameters  (Taylor,  Harris)  "  are  increased  to  the  extent  of 
one  inch  for  the  cavity  and  inferior  strait."  If  the  conju- 
gate is  not  materially  lengthened,  the  cavity  is  greatly  ampli- 
fied.^ This  amplification  is  what  is  needed  to  effect  delivery 
in  the  class  of  pelvic  distortions  which  have  been  considered. 
If  necessary,  delivery  may  be  facilitated  by  the  forceps.^  In 
fact,  symphysiotomy,  premature  labor,  and  the  forceps  may 
be  combined,  and  the  delivery  of  a  living  fcetus  accomplislied 
without  detriment  to  the  mother.  The  pubic  section  is  not, 
however,  recommended  when  the  conjugate  is  less  than  two 
and  five-eighths  inches,*  and  consequently  does  not  cover  the 
precise  limits  of  three-fourths  of  an  inch  between  two  and 
one-half  and  three  and  one-fourth,  in  which   its  advocates 


1  Personal  communication,  December  22,  1887. 

2  In  Naples  the  section  is  made  subcutaneously  with  the  probe-pointed  and  sickle- 
shaped  bistoury  of  Galbiati.  An  incision  is  made  above  the  pubis,  and  the  knife 
slowly  passed  behind  the  symphysis  until  it  reaches  the  pubic  arch,  when  the  Uga- 
ments  are  divided  from  below  upward.  The  pelvis  is  not  forced  open,  neither  is  the 
fcBtus  turned  or  dragged  upon,  but  when  the  head  presents  the  case  is  left  mainly  to 
nature.  In  about  one  case  out  of  four  the  forceps  are  applied.  The  incised  part  is 
treated  antiseptically,  and  by  irrigation  if  in  warm  weather.  As  soon  as  convenient 
the  ossa  pubis  are  kept  in  apposition  by  an  immovable  apparatus,  to  secure  an  early 
union  of  the  severed  parts. — Harris  :  loc.  cit.,  p.  27 

3  In  the  new  symphysiotomy  of  Naples  version  isinever  used,  hence  the  escape  of 
pelvic  injury  and  the  diminished  foetal  death-rate. 

*  In  the  cases  reported,  the  conjugate  ranged  between  three  and  one-quarter  and 
two  and  one-half  inches.  Raflfaele  reports  for  Morisani  a  case  operated  on  at  the 
beginning  of  the  eighth  month,  in  which  the  conjugate  measured  only  two  and  three- 
sixteenths.  The  patient,  forty  days  after  the  operation,  walked  without  incon- 
venience.   Labor  was  artificially  induced,  and  the  woman  delivered  herself. 


KSSA  ys  AND  Annni-JS'SES.  235 

(ilnim  llijit  (M'Miiiotoiiiy  is,  /kw  exceUeiux,  tlio  clccLiv*;  ojxiru- 
tion. 

If  I  should  rest  the  argument  here,  it  might  be  maintained 
tliat  version,  the  indncition  of  promatm'e  labor,  and  symphyH- 
iotomy  failed  to  supply  sullieicMiL  oj)portuniti(!.s  for  (h'livery 
between  those  limits  separated  only  a  fraction  of  ;m  incli,  and 
that  {!ranit)tomy  would  be  o(|ually  jircfcrable  in  conditions  of 
pelvic  obstruction  other  than  those  caused  by  bony  deformity, 
as  in  those  cases  where  version  or  the  forceps  had  proved  in- 
effective. Its  advocates  cannot  be  permitted  to  cover  retreat 
even  under  such  ambiguous  assumptions.  The  important 
and  substantial  improvements  in  the  external  methods  leave 
it  without  justification  even  as  an  nltimate  resort  in  these 
debatable  conditions. 

The  Cajsarean  section  and  its  substitutes  offer  additional 
preferable  procedures.  The  weight  of  the  later  and  more 
recent  authorities,  other  than  the  British,  is  vastly  in  favor 
of  this  operation  when  the  conjugate  is  one  and  one-half 
inches  or  less.  In  fact,  it  cannot  be  said  that  craniotomy 
competes  with  it  when  the  conjugate  is  two  inches  or  less, 
and  even  when  the  measurement  reaches  two  and  one-half  its 
performance  is  considered  by  some  of  its  warmest  adherents 
of  doubtful  propriety.^  If  the  relative  merits  of  the  two 
methods  are  to  be  studied  with  impartiality,  they  ought  to 
be  measured  by  their  respective  results  in  like  conditions  of 
pelvic  obstruction  below  the  maximum  conjugate  at  which 
either  is  admissible,  and  not  by  excluding  from  the  mortality 
of  craniotomy  its  disastrous  results  to  mothers  in  the  higher 
grades  of  diminution  of  the  conjugate  and  the  total  loss  of 
children  at  all  grades.  It  does  not  subserve  the  purposes  of 
science    to    limit    one  to  an  elective  sphere  of  very  narrow 

1  Aceordiug  to  the  investigations  of  Parry,  whose  decision  I  have  verified  by  my 
own  researches,  craniotomy  has  scarcely  a  fractional  advantage  in  saving  life  over 
gastro-hysterotomy  in  cases  where  the  conjugate  diameter  of  the  superior  strait 
measures  two  and  one-half  inches  or  less,  and  not  eveu  this  claim  when  the  latter  is 
performed,  as  it  should  be,  very  early  in  labor.— Harris :  American  Journal  of  the 
Medical  Sciences,  vol.  Ixxvii.  p.  46. 


236  ESSAYS  AND  ADDRESSES. 

proportions,  where  even  its  best  results  will  not  save  50  per 
centum  of  the  lives  imperilled,  and  compare  such  percentage  of 
maternal  recoveries  with  those  obtained  from  Csesarean  sec- 
tion and  its  substitutes  extended  over  a  far  larger  field  and 
applied  to  less  favorable  conditions.  But  even  this  method 
of  investigation  does  not  present  the  external  operations  per- 
formed during  the  past  five  years  in  a  less  advantageous  aspect 
than  craniotomy.  Harris  has  shown  that  when  Cesarean 
section  has  been  performed  during  the  first  twenty-four  hours 
after  labor  has  begun,  74  per  cent,  of  women^  were  saved  and 
81  per  cent,  of  children  delivered  alive.  Deufeillay  (Lusk) 
has  shown  that  in  timely  operations  81  per  cent,  of  mothers 
are  saved.  In  the  Santa  Caterina  of  Milan  and  the  Krank- 
enhaus  of  Vienna  (Harris)  the  Porro-Csesarean  operation  has 
saved  73  per  cent,  of  women  and  all  the  children.  The  appli- 
cation of  antisepsis  has  so  greatly  improved  the  results  in 
other  abdominal  operations  that  no  one  can  doubt  that  it  will 
prove  equally  beneficial  in  these.  This  seems  to  have  been 
already  demonstrated  by  the  immensely  (Eustache)  more 
favorable  results  to  both  mother  and  child  which  have  been 
achieved  in  recent  years.  "  The  effects  of  antiseptic  (Harris) 
measures  and  greater  cleanliness  have  been  shown  by  the  re- 
sults of  the  Porro  and  other  capital  operations  in  large  lying-in 
institutions,  and  in  nothing  more  than  the  entire  change  of 
results  in  the  two  maternities  of  Naples,  in  which  the  old  and 
the  new  pubic  sections  have  been  performed.  Perhaps  no 
tabular  record  of  Italian  surgery  is  so  much  to  the  point  in 
exhibiting  the  possible  variation  of  results  from  unfavorable 
to  favorable  as  that  prepared  upon  the  first,  second,  and  third 
hundred  ovariotomies  by  Dr.  Peruzzi.  From  having  lost 
nine  of  the  first  operations  in  succession  before  achieving  one 
success,  they  have  gradually  improved  in  results  until  now 
the  mortality  is  reduced  to  a  moderate  percentage." 

1  Of  the  one  hundred  and  thirty-two  operations  performed  in  North  America  prior 
to  July,  1882,  49=/n  per  cent,  of  women  were  saved.— Harris  :  Ibid.,  vol.  xxxiT. 
p.  155 


KS.SAVS  AND  A  DDIlHSSKS.  237 

Even  wlicn  liiiiitcd  lo  tlu!  narrow  uiva  of  it.s  rhoson  fif;Ul  of 
election,  craniotomy  can  in-vcsr  k.-ivc!  tlic  percentage  of  lives 
already  ohtainctd  by  ^astro-liysl('r()toiiiy  and  its  nutdiiicatifJiiH, 
nor  can  it  ever  attain  the  brilliant  resnlt.s  of  the  Porro  sub.sti- 
tute,  which  for  the  whole  number  of  operationH  has  saved  45| 
per  cent,  of  mothers  and  ll-^.j  ]ier  cent,  of  children.  In  fact, 
from  a  later  classification  by  Harris  {American  Journal  of  the 
3£edioal  Sciences,  October,  1 883,  p.  438),  it  appears  that  the 
Porro  operation,  carried  out  as  originally  designed,  has  saved 
46]:f  per  cent,  of  the  cases;  the  Porro-Miiller  method,  un- 
modified, has  saved  52]-^  per  cent. ;  and  the  two  combined, 
48^*9  per  cent,  of  women,  and  90  out  of  118  children.'  In 
view,  then,  of  the  greater  number  of  lives  saved,  and,  in  fact, 
when  all  the  conditions  and  circumstances  are  impartially  con- 
sidered, the  greater  number  of  mothers  saved,  the  classical 
Caesarean  section,  and  its  modification  and  substitutes,  must 
be  regarded  as  conservators  of  life.  But  this  is  not  all ; 
Csesarean  .section  may  restore  to  women  incapacitated  by 
pelvic  deformity  the  privilege  and  power  of  giving  birth  to 
an  indefinite  number  of  living  children.  Lungren"  has  shown 
that  in  one  hundred  and  nineteen  multiple  operations  upon 
forty-eight  women  there  were  only  eight  mothers  lost.  In 
three  of  these  cases  the  operation  was  performed  seven  times, 
in  two  six  times,  in  one  five  times,  in  three  four  times,  and 
in  three  three  times,  all  of  which  recovered.  The  Porro 
modification  has  not  only  saved  a  larger  percentage  of  lives, 
but  prevents  subsequent  pregnancies,  and  therefore  in  such 
cases  there  cannot  occur  such  successive  repetitions  of  crani- 
otomy as  related  iu  the  case  before  cited.  In  the  face  of  such 
facts,  can  the  most  enthusiastic  craniotomist  continue  to  class 
the  operation  among  the  elective  procedures  ?^     It  has  been 

1  The  Sanger  operation  in  Europe  saved  forty  women  and  forty-eight  children  out 
of  the  lirst  fifty,  in  chronological  order,  and  the  Porro  twenty-one  in  fifty, — Harris  : 
Personal  comrauuication,  December  22,  1S87. 

2  American  Journal  of  Obstetrics,  vol.  xiv.  p.  7S. 

s  Keyser  estimates  the  mortality  from  second  operations  on  the  same  woman  at 
29  per  cent. ;  in  the  United  States  it  has  been  25  per  cent.— Harris :  American  Journal 
of  the  INiedical  Sciences,  vol.  Isxii.  p.  61. 


238  ESSAYS  AND  ADDBESSES. 

alleged  that  iu  occasional  instances  women  have  after  one 
craniotomy  given  birth  per  vias  naturales  to  living  children, 
and  such  is  probably  true ;  but  it  only  proves  that  either  the 
operation  was  hasty  aud  unnecessary  in  the  first  pregnancy, 
or  that  the  obstruction  was  due  to  disproportion  of  the  foetal 
head  or  to  impaction  of  the  foetus  in  a  transverse  position. 
The  rule  is  that  each  subsequent  foetus  has  been  killed  and 
mutilated,  as  in  the  case  cited  by  Harris  (see  note,  page  233), 
or  one  of  the  external  operations  has  been  finally  resorted  to, 
as  in  the  case  of  Mrs.  Reybold,  with  equally  satisfactory 
results.^ 

It  is  not  necessary  in  this  connection  to  discuss  the  relative 
merits  of  the  classical  Csesarean  section  and  its  substitutes, 
nor  to  point  out  the  indications  which  should  give  one  or  the 
other  the  preference.  Garrigues,^  Harris,  and  others  have  so 
fairly  and  ably  reviewed  these  questions  that,  even  if  relevant 
to  the  present  issue,  I  could  afford  to  pass  them  with  this 
reference. 

Nor  is  it  necessary  that  I  should  review  in  detail  the 
comparative  merits  of  craniotomy  and  its  alternatives  in  the 
minor  and  rarer  forms  of  obstruction  to  labor.  In  the  very 
rare  forms  of  pelvic  distortion,  as  in  the  oblique-ovate,  the 
Csesarean  section  is  generally  most  strongly  advocated.  The 
time  has  probably  passed  when  anyone  would  hold  crani- 
otomy on  the  living  foetus  justifiable  in  cases  of  cancer  of  the 
cervix  uteri  or  advanced  phthisis.  The  results  in  either  case 
are  equally,  if  not  more,  favorable  when  left  to  nature  un- 
aided, or,  at  most,  assisted  by  the  forceps  or  version.  In 
transverse  positions  Harris  has  shown  that  in  the  United 
States  twelve  Csesarean  sections  have  yielded  nine  suc- 
cesses. But  neither  cancer,  malacosteon,  exostoses,  nor  uterine 
fibroids  contraindicate  Csesarean  section  or  its  substitutes.     In 

1  We  have  had  women  in  this  country  who  have  endured  several  hours  of  suifering 
under  craniotomy,  and  narrowly  escaped  with  their  lives,  who  were  afterward 
delivered  safely  of  living  children  by  gastro-hysterotomy.— American  Journal  of  the 
Medical  Sciences,  vol.  Ixxvii.  p.  59. 

2  American  Journal  of  Obstetrics,  vol.  xvi.  p.  337. 


I']SSA  VS  AND  ADDRESSES.  289 

pregnancy  <'<»iii|)II('iil(!(l  wiili  (il)i'io(l  liiiiioi'soC  tlif;  iiUtniH  it.  Iia.s, 
howev(!i',  |)r()V(!(l  very  unfavorable  in  tliiH  (;ountry,  hrioaiise 
of  the  att(!n(liii(j;  cxlianstinn;  licinorrliagc  ;  yet  in  Horno  it  is 
not  only  tiie  bt'sl  but  tlu;  only  possihl*!  operation  ((iarrigiu-Hj, 
as  in  Sanger's  case,  where  a  fibroid  as  largo  as  a  cliiUPs  head 
sprang  from  th(!  postcM'ior  wall  of  the;  cervix. 

Professor  G.  Eustuche  (Lille,  Belgium)  (loneludes  a  paper 
on  the  ''  Parallel  between  Embryotomy  and  the  Csesarean 
Section/'  read  before  the  London  International  Congress,  as 
follows:  '^  Considering,  on  the  one  hand,  (1)  the  recent  re- 
sults of  ovariotomy  and  of  all  other  abdominal  sections;  (2) 
the  improvement  in  the  prognosis  of  all  surgical  injuries 
under  antiseptic  treatment ;  (3)  the  success  of  Porro's  opera- 
tion ;  (4)  the  immensely  favorable  results  both  to  mother  and 
child  after  the  Cesarean  section,  which  have  been  published 
during  recent  years." 

"  And  considering,  on  the  other  hand,  that  embryotomy, 
while  it  always  sacrifices  the  child,  exposes  the  mother  to  as 
grave  dangers  as  the  Ctesarean  section  ;  that  it  is  inapplicable 
in  many  cases  of  deformed  pelvis,  e.g.,  when  the  conjugate 
is  five  centimetres  and  under." 

'^  I.  When  the  child  is  living  at  the  beginning  of  labor, 
and  when  the  pelvic  strait  is  under  78  mm. — the  extreme 
limit  for  the  application  of  the  forceps — the  Caesareau  opera- 
tion should  be  performed  early ;  that  is  to  say,  as  soon  as 
labor  has  really  set  in,  and  with  antiseptic  precautions." 

'^  II.  When  the  child  is  dead  and  the  superior  strait  meas- 
ures five  centimetres  recourse  should  be  had  to  embryotomy. 
Below  five  centimetres  the  Cffisareau  section  becomes  an  opera- 
tion of  necessity." 

"  To  sum  up,  the  Caesarean  section  should  be  the  method 
of  election,  embryotomv  that  of  exception."^ 

Harris"  struck  the  kevuote  of  success  when  he  wrote  "  that 
the  first  and  most  important  step  is  to  make  the  operation  one 

1  Ibid.,  vol.  xiv.  pp.  944,  945.  «  Amer.  Journ.  Med.  Sci.,  vol.  Ixxxiii.  p.  374. 


240  ESSAYS  AND  ADDBESSES. 

of  anticipation  and  choice,  rather  than  one  of  dire  necessity 
and  last  resort."  The  largely  increased  percentage  of  recov- 
eries in  the  timely  operations  has  demonstrated  beyond  dis- 
pute that  delay  is  the  chief  factor  of  danger.  The  exhaustion 
of  the  patient  and  bruising  of  the  soft  parts  by  long-continued 
ineffectual  efforts  to  accomplish  delivery  through  the  natural 
passages  have,  in  very  many  cases,  destroyed  every  prospect 
of  recovery  before  the  operation  was  begun.  ''A  very  early 
operation  (Harris)  in  the  United  States  will  save  three  out  of 
four  women  and  as  many  children  ;  a  moderately  late  one  will 
lose  about  two  out  of  three,  and  one-half  the  children  ;  and  a 
very  late  operation — that  is,  from  three  to  fifteen  days  or  more 
after  the  commencement  of  labor — will  lose  three,  four,  or  five 
to  one,  according  to  circumstances."^  The  application  of  an- 
tisepsis,^ improvements  in  the  method  of  operating,  manage- 
ment of  the  uterine  wound,  and  subsequent  treatment  of  the 
patient  have  contributed  largely  to  the  better  success.  And 
to-day  the  prospect  is  so  encouraging  that  even  the  most 
skeptical  will  soon  be  compelled  to  accept  the  results  as 
conclusive. 

So  much  for  the  obstetric  and  surgical  substitutes  for  crani- 
otomy. There  is  another  plan  of  treatment  even  more  con- 
servative than  either  of  the  procedures  heretofore  considered. 
Nature,  says  Lusk,^  will,  under  favorable  circumstances,  in 
all  but  the  extreme  forms  of  pelvic  contraction,  "  do  her  own 
work  with  the  least  expense  of  infant  life,  and  with  a  relatively 
small  maternal  mortality,"  He  cites  the  fact  that,  in  cases 
of  contracted  pelvis  in  the  Dresden,  Leipsic,  and  Breslau 
Maternities,  ^'four  hundred  and  seven  spontaneous  deliv- 
eries took  place  with  the  loss  of  fifty-three  children,  and, 
from  puerperal  diseases,  of  twelve  mothers,  the  latter  repre- 
senting very  nearly  the  usual  mortality  in  lying-in  hospitals." 
By  favorable  circumstances  he  means  a  "  presentation  and 

'  Amer.  Joum.  Med.  Sci.,  vol.  Ixxvii.  p.  62. 

2  Garrigues  :  American  Journal  of  Obstetrics,  vol.  xvi.  p.  508. 

3  The  Science  and  Art  of  Midwifery,  p.  476. 


ESSA  YS  A  Nh  A  DhllESSESi.  24 1 

poHitioii  of  tlio  (tliild'.s  lioud  .suited  to  tin;  form  of  tlic  j)elvi8, 
and  a  Huflficient  dej^ree  of  uterine  activity."  I  have  previ- 
ously incidentally  referred  to  unnecessary  and  hasty  cranioto- 
mies and  to  the  dangers  of  delay  in  the  performance  of  its 
substitutes.  These  can  only  be  avoided  by  a  careful  and 
accurate  study  of  the  existing  conditions,  based  upon  a  com- 
plete knowledge  of  tlie  obstacles  presented  and  applicability 
of  the  methods  of  j)rocedur('.  Tiie  wisest  course  will  always 
yield  the  best  results,  but  when  to  interfere  and  how  to  pro- 
ceed are  not  always  cither  easily  or  quickly  determined. 
Human  judgment,  even  when  supported  by  intelligent  expe- 
rience and  the  highest  scientific  attainments,  is  not  infallible. 
The  expectant  plan  of  treatment  is  not  mere  guesswork  or 
the  haphazard  conclusion  of  the  tyro,  but  the  deliberate  judg- 
ment of  one  who  knows  what  not  to  do  as  well  as  what  to 
do  and  when  to  do  it.  It  is  not  the  sloth  of  idle  expecta- 
tions, but  the  masterly  inactivity  of  experience,  discretion, 
and  knowledge. 

But,  after  all,  the  question  hangs  upon  the  right  of  elec- 
tion between  two  lives  at  stake.  Just  so  long  as  this  right  is 
maintained  just  so  long  craniotomy  will  have  its  advocates 
and  operators.  The  law  of  justification  will  always  be  in- 
voked to  cover  tiie  plea  of  necessity.  If  the  life  of  the 
mother  could  certainly  and  only  be  saved  by  the  killing 
of  her  foetus,  and  the  death  of  both  was  otherwise  inevitable, 
the  execution  of  the  child  might  be  justifiable  as  the  only 
alternative.  But  no  such  relation  of  conditions  ever  did  or 
can  exist.  Unless  delivery  is  accomplished,  both  lives  will 
be  sacrificed,  but  the  killing  of  the  foetus  is  not  necessary  to 
and  does  not  guarantee  the  recovery  of  the  mother.  Xeither 
are  the  'two  lives  in  equal  danger.  Either  may  be  saved  with 
or  without  the  saving  of  the  other.  Craniotomy  offers  no 
chance  to  the  foetus,  but  a  reasonable  prospect  of  recovery  to 
the  mother.  Its  substitutes  offer  three  out  of  four  chances 
to  the  foetus,  and  quite  equal,  or,  at  most,  but  slightly  les- 
sened chances  to  the  mother.     Then  it  must  follow  that  this 

16 


242  "  ESSAYS  AND  ADDRESSES. 

right  of  election  subordinates  the  Hfe  of  the  foetus  and  the 
larger  number  of  lives  to  the  possible  enhancement  of  the 
chances  of  life  to  the  mothers,  and  relegates  the  resources  of 
obstetric  science,  which  offer  in  the  aggregate  largely  more 
favorable  results,  to  the  category  of  methods  of  dire  neces- 
sity and  almost  hopeless  resort.  It  is  not,  then,  the  greatest 
good  to  the  greatest  number,  but  the  offer  of  possibly  im- 
proved prospects  to  the  chosen  few.  Is  that  the  humanity 
which  the  science  of  medicine  should  espouse  and  proclaim  to 
the  world  as  an  illustration  of  its  beneficence  ? 

This  right  of  election  is  furthermore  based  upon  the  alleged 
greater  value  of  the  life  of  an  adult  woman  than  that  of  her 
unborn  child.  By  whom,  and  in  what  manner,  is  this  valu- 
ation to  be  estimated  ?  Is  it  a  mere  matter  of  trade  and 
business,  to  be  determined  always  in  favor  of  one  because  the 
future  and  possibilities  of  the  other  cannot  be  known  ?  Are 
social  position,  personal  qualities,  and  domestic  relations  com- 
modities of  value  to  be  purchased  at  the  cost  of  the  life  of  the 
unborn  ?  But  it  so  happens  that  one  such  life  would  rarely 
liquidate  such  indebtedness.  If  the  right  to  take  life  on  such 
a  pretext  is  indisputable,  the  number  of  such  sacrifices  can 
only  be  determined  by  the  number  of  subsequent  pregnan- 
cies, and  the  breeding  and  killing  may  go  on  at  the  pleasure 
of  the  woman  and  will  of  the  executioner.  Even  the  most 
uncompromising  advocate  of  the  murderous  operation  could 
not  view  such  a  picture  without  the  utmost  abhorrence. 

The  relative  value  of  two  lives  cannot  be  the  only  arbiter, 
for  every  life  is  of  equal  value  to  every  holder.  It  is  true 
that  the  foetus  has  not  gained  an  independent  existence.  It 
is,  nevertheless,  true  also  that  in  these  cases  it  is  the  life  of  a 
woman  who  cannot  give  birth  to  a  living  child  per  vias  natu- 
rales.  And  such  incapacity  is  the  one  and  only  claim  of  right 
to  destroy  the  foetus.  Can  such  a  right  rest  exclusively  upon 
such  a  basis,  when  it  is  established  that  other  procedures  offer 
almost,  if  not  quite,  equal  chances  of  the  mother's  recovery, 
and  rescue  the  larger  number  of  children  imperilled  ? 


ESSAYS  AND  ADDRESSES.  243 

It  is,  moreover,  claimed  that  a  inotlKir'n  life  m  above  arul 
beyond  any  and  every  eonsid(!ration  of  a  ffetn.s  in  utero.  A 
specious  subterfuf^e  !  J>iit  very  few,  if  any,  Hudi  women 
could  ever  become!  mothers  unh'ss  the  delivery  of  a  living 
child  is  a(!complished  by  one  of  the  conservative  mftlKKls. 
Not  one  of  the  forty  women  cited  by  Lungren  could  ever 
have  had  a  child  to  f<)ster  or  could  ever  have  experieiifcd 
the  first  pleasure  of  a  reali/x'd  maternity  but  for  the  Ctesarean 
section  or  one  of  its  substitutes ;  and  the  woman  who  had 
submitted  sixteen  fcetuses  to  destruction  might  have  added 
one  or  more  but  for  the  timely  accident  which  Providence 
interposed  as  its  expression  of  abhorrence. 

It  is  also  alleged  that  the  law  of  moral  responsibility  im- 
poses the  obligation  of  professional  duty  to  destroy  the  foetus 
that  the  chances  of  the  woman's  recovery  may  be  improved. 
In  timely  Csesarean  sections  74  per  cent,  of  women  and  80 
per  cent,  of  children  ;  in  the  recent  Porro-Caesarean  operation 
73  per  cent,  of  mothers  and  all  the  children  have  been  saved; 
and  in  the  first  fifty  Sanger  operations  80  per  cent,  of  mothers 
and  96  per  cent,  of  children  have  been  saved.  These  results 
are  comparable  with  80  per  cent,  of  recoveries  of  women  and 
loss  of  all  the  children  after  craniotomy.  It  may  be  that  if 
the  comparisons  were  based  upon  the  results  of  craniotomy 
during  the  last  few  years  it  would  be  less  unfavorable.  Surely 
such  a  law  or  duty  cannot  find  its  vindication  in  these  data, 
and  its  supporters  must  seek  some  other  defence  than  results. 
If  such  a  law  or  rule  of  conduct  has  any  foundation  at  all,  it 
is  the  unwritten  ipse  dixit  of  by-gone  periods — the  outgrowth 
and  excuse  of  a  dire  necessity,  which  science  never  did  accept 
and  can  no  longer  tolerate. 

The  beneficence  of  medical  science  consists  in  the  alleviation 
of  suffering  and  the  prolongation  and  saving  of  life.  In  the 
face  of  the  facts  hereinbefore  presented  there  can  be  no  rule 
of  morals  or  of  duty  which  clothes  it  with  the  prerogative  to 
take  life  as  a  mere  choice  of  obstetric  or  surgical  procedures, 
and  this,  too,  when  such  choice  incurs  the  responsibility  of 


244  ESSAYS  AND  ADDRESSES. 

its  repetition,  while  another  operation  might  have  either  pre- 
vented any  subsequent  pregnancy  or  fitted  her  to  bear  living 
children  independent  of  her  physical  incapacity. 

If  more  attention  was  paid  to  the  saving  and  more  regard 
held  for  the  life  of  the  foetus,  more  women  would  be  saved. 
The  dangers  of  delay  would  be  avoided  and  the  life  of  the 
foetus  would  not  be  lost  in  ineffectual  and  unskilful  efforts  to 
accomplish  delivery  of  a  living  child  through  the  natural 
passages  when  the  obstruction  precluded  its  possibility.  It 
would  demand  an  early  diagnosis  of  the  condition,  and  in- 
voke a  more  minute  and  more  general  study  of  the  causes  of 
obstructive  labor  and  the  proper  methods  of  procedure.  The 
sentiment  of  a  higher  responsibility  would  be  infused,  and 
the  pride  and  glory  of  saving  two  lives  would  oftentimes 
supplant  the  detestable  act  of  killing  one  and  possibly  losing 
both. 

In  conclusion,  I  disclaim  any  assault  upon  individual 
opinion  or  practice.  I  have  endeavored  to  consider  the 
question  in  its  scientific  aspect,  and  entirely  free  from  the 
influence  of  eccelesiastical  doctrines.  I  fully  realize  the 
embarrassment  of  individual  cases  when  a  professional 
brother  may  be  dizzied  by  the  emotional  appeals  of  a  false 
and  sentimental  humanity  and  his  judgment  made  to  swerve 
from  a  sound  discretion  and  logical  conclusions  to  the  adop- 
tion of  a  plan  of  treatment  which  the  experience  of  past  ages 
has  handed  down  to  us,  and  vindicated  by  the  assertion  of 
the  right  to  take  one  life  rather  than  leave  two  to  die.  But, 
in  the  interest  of  a  broader  humanity  and  a  far  wider  field  of 
usefulness,  I  would  follow  the  pathway  illumined  by  science 
and  supported  by  the  results  of  recent  progress,  and  offer 
chances  to  two  lives  rather  than  take  the  one  which  cannot 
assure  the  safety  of  the  other. 


ESS  A  YS  A  NJ)  ADD  li  EHSKS.  215 


PRiI^:SES    ET   RECTOR. 

ALAf^    UNIVEKSITATIS    SANCT^.    MAIlIiE    BALTIMORENSIS 

OMNIBUS   ET   SINGULIS   PR/ESENTE3   LITTEUAS    IX- 

SPECTURIS   PACEM   ET  SALUTEM   IN   DOMINO. 

Cum  in  optiraariim  artium  studio,  nou  secus  ac  in  exequcn- 
(lis  muneribus,  illos  dignitate  antecellcre  congruat,  laureaque 
decorari  quos  majoruni  labornra  assiduitas  insignes  reddicHt, 
Alma  Universitas,  pro  concessa  Sibi  anctoritate,  eommunibus 
votis  dignum  omniuo  judicavit  quern  inter  Doctores  in  jure 
adscriberet  D.  Samuelem  Clagett  Busey,  jam  medicinae 
Doctorem  celeberrimum.  Qui,  dura  indefessa  cura,in  allevian- 
disc  urandisque  iufirmorum  morbis,  per  multos  annos  incura- 
beret,  moralibus  disciplinis  adjumenta  ex  physiologicis  scientiis 
contra  pessiraam  craniotomife  praxim  mimistravit.  Sic  ver 
egregiusse,  ternseque  supremse  Legis  principia  optime  cal- 
lentem  se  exhibuit,  eademque  luculenter  exposnit  et  strenue 
propugnavit,  probe  intelligeus  artem  medicani  cum  altioribus 
naturalis  diviuique  juris  priucipiis  ultime  conjungi,  imo  ab 
illis  peudere.  Quse  quidem  omnia  quum  certissime  uon  solum 
fama  referente,  sed  etiam  propria  nostra  cognitione  evidenter 
coustent,  laudatum  D.  Samuelem  Clagett  Busey,  unan- 
imi  Alm83  Universitatis  Professorum  suffragio,  Doctorem. 
In  Jure  renunciamus,  collatis  eidem  omnibus  honoribus  ac 
privilegiis,  quibus  cffiteri  Doctores  rite  promoti  potire  consue- 
veruut. 

In  cujus  rei  testimonium  prtesentes  litteras  chirographo 
nostro  in  majori  sigillo  Alms  Universitatis  munitas  expediri 
curavimus. 

Datum  in  JEdibus  Universitatis  Sanctte  Mariae  Baltimoren- 


246  ESSAYS  AND  ADDRESSES. 

sis,  die  VI,  mensis  Januarii  anno  reparatse  Salutis,  MDCCC- 
LXXXVIII. 

A.  Magniex,  S.S.,  S.T.D., 

Praeses. 


-<^-^'" 

SA.Yc:r,^ 

/ 

6 

^ 

^ 

w 

^. 

?* 

^^ 

^ 

^>, 

.-^ 

.4^ 

•%^^'" 

X 

St.  Mary's  Seminary,  North  Paca  Street, 
Baltimore,  Md.,  January  13, 1888. 

Dr.  Samuel  C.  Busey. 

Dear  Doctor  :  It  gives  me  and  the  professors  of  St. 
Mary's  University  great  pleasure  to  confer  upon  you  the  de- 
gree of  Doctor  in  Law. 

Your  well-known  merit,  your  science  and  zeal  in  the  pro- 
motion of  good  morals  and  the  sound  principles  of  Divine 
and  natural  law  in  your  profession  as  a  medical  doctor,  have 
w^on  for  you  the  esteem  and  even  admiration  of  many,  and 
principally  of  the  Catholic  clergy,  whose  high  mission  you  so 
well  understand,  and  have  constantly  seconded  with  much 
success. 

Believe  me,  dear  Doctor, 

Your  devoted  and  obedient  servant, 

A.  Magnien,  S.S.,  D.D. 

1545  I  Street  N.  W., 
Washington  City,  January  14, 1888. 

To  the  President  and   Professors  of   St.    Mary's 
University. 
Reverend  Fathers  :    I  beg  that  you  will  accept  my 
grateful   acknowledgment  of  the  distinguished    honor   you 


ESSAYS  AND  ADDRESSES  247 

luive  conferred   upon  ine  by  decorating  nic  with  tlie  degree 
of  LL.D. 

'^I^ln's  liii:;h  dislinction  comes  to  me,  us  stated  in  the  dij)Ioma, 
for  the  maintenance  of  convictions  which  were  the  result  of 
considerations  entirely  free  from  ecclesiastical  influence,  and 
is  the  more  valued  because  of  the  independent  act  of  the 
Faculty,  the  members  of  which  are  personally  unknown  to  me. 

The  convictions  referred  to  relate  to  the  obligations  of  phy- 
sicians to  save  life,  and  the  belief  that  science  and  religion 
are  not  antagonistic.  My  abhorrence  of  the  operation  of 
craniotomy  induced  me  to  review  this  subject  in  its  scientific 
aspect,  and,  when  the  conclusion  which  you  so  heartily  ap- 
prove had  been  reached,  duty  compelled  me  to  promulgate  it. 
This  announcement  invoked  the  adverse  criticism  of  many 
physicians  which  I  have  borne  in  silence  and  without  remon- 
strance until  now.  I  have  the  gratification  of  knowing  that 
my  indorsers  are  now  more  numerous  than  my  censors. 

The  St.  Mary's  University  is  the  first  institution  of  learn- 
ing to  approve  publicly  my  course. 

Please,  also,  accept  the  expression  of  my  appreciation  of 
the  graceful  and  complimentary  terms  which  you  have  chosen 
to  convey  to  me  the  action  of  the  Faculty  over  which  you 
have  so  long  presided  with  such  dignity  and  honor  to  yourself 
and  associates. 

Yours,  very  truly, 

"   S.  C.  BUSEY. 


ADDRESS   OF    ^YELCOME 

TO    THE    AMERICAN    GYNECOLOGICAL    SOCIETY,    DELIVERED 
AT   WASHINGTON,    SEPTEMBER    22,  1885. 

Mr.  President  and  Fellows  :  I  offer  you  the  greetings 
of  fellowship,  and  bid  you  welcome  guests  of  the  Washington 
Obstetrical  and   Gynecological  Society.      The  acceptance  of 


248  ESSAYS  AND  ADDRESSES. 

the  invitation  to  hold  yonr  tenth  annnal  meeting  in  this  city 
and  your  presence  here  to-day  confer  a  distinguished  honor 
upon  our  young  Society,  now  just  completing  its  third  year  o£ 
existence,  and  affords  an  opportunity  for  its  members  to  meet 
and  make  the  acquaintance  of  men  who,  by  their  brilliant 
achievements  in  the  sciences  of  obstetrics  and  gynecology, 
have  won  world-wide  reputations,  and  added  lustre  and  re- 
nown to  American  medicine. 

We  extend  to  you  the  hospitalities  of  fraternity,  and,  by 
our  presence  at  this  opening  session,  attest  our  professional 
regard  and  obedience  to  parental  precept  and  authority. 

It  is  a  special  gratification  to  know  that  the  youngest  of 
your  natural  offspring  will  enjoy  the  honor  of  commemora- 
tive union  on  this  tenth  anniversary  of  a  Society  which,  in  the 
past  decade,  has  contributed  so  much  to  the  advancement  of 
obstetrics  and  gynecology,  and  to  the  cure  and  alleviation  of 
the  afflictions  of  woman. 

On  the  roster  of  Fellowship  the  names  of  Atlee,  Bucking- 
ham, Peaslee,  Sims,  Trask,  Wallace,  and  White  are  marked 
with  the  asterisk  of  death.  Others  have  come  to  fill  the  places 
of  the  lamented  dead,  and  the  future  gives  promise  of  even 
greater  progress  and  higher  excellence  in  the  aims  of  conscien- 
tious and  scientific  medicine. 

Then  here,  at  the  nation's  capital,  on  this  auspicious  occa- 
sion, in  the  unity  of  a  common  purpose,  let  us  join  with  you 
in  that  faith  and  devotion  to  duty  which  have  been  crowned 
with  such  marvellous  success  and  rich  rewards.  You  must 
lead ;  we  will  follow.  And,  when  you  have  completed  the 
labors  of  the  present  meeting,  and  the  new  and  renewed  friend- 
ships shall  be  interrupted  by  your  return  to  the  scenes  of  your 
daily  work,  if  our  gratitude  as  pupils  shall  be  the  measure 
of  your  pleasure  as  instructors,  your  second  advent  will  not 
await  the  expiration  of  another  decade. 


I'JSSA  I'.V  AM)  An  DRESSES.  249 


THE   HYGIENE   OF   PREGNANCY. 

DELIVERED    J5Y    THE    PRESIDENT    OP    THE    WASHINGTON 

OBSTETRICAL   AND   GYNECOr/XilCAL   SOCIETY, 

OCTOBER   2,    1885. 

In  a  recent  contribution'  I  expressed  the  opinion  tliat  the 
natural  laws  governing  the  childbearing  life  of  woman  should 
constitute  safer  guides  for  the  sanitation  of  pregnancy  than 
the  artificial  methods  which  necessity  and  experience  have 
invoked.  I  did  not,  however,  mean  to  undervalue  the  expe- 
dients and  procedures  which  medical  skill  and  science  offer  to 
prevent,  mitigate,  and  cure  the  diseases  of  pregnancy.  Whilst 
I  maintain  that  these  laws  should  constitute  the  fundamental 
basis  of  any  code  of  hygiene  that  will  attain  the  highest  aim 
in  the  prevention  of  the  diseases  of  pregnancy,  reduce  the 
mortality  of  childbearing  to  its  minimum,  and  promote  the 
longevity  of  post-cessation  life,  I  am  compelled  to  admit  the 
impossibility  of  their  general  enforcement.  The  duty,  then, 
devolves  upon  the  profession  to  devise  other  methods  of  con- 
servation of  the  lives  of  pregnant  women  which,  if  not  the 
best,  will  secure  the  best  results  human  skill  can  reach. 

For  convenience,  I  limit  the  hygiene  of  pregnancy  to  the 
preservation  of  the  health  of  woman  during  those  periods  of 
her  life  beginning  with  conception  and  terminating  with  the 
commencement  of  labor.  This  is  an  arbitrary  limitation, 
for  it  cannot  be  technically  asserted  that  pregnancy  is  con- 
cluded until  the  womb  is  completely  evacuated  of  foetus  and 
seeundiues.  It  excludes  also  the  diseases  of  intrauterine  life. 
The  preservation  of  the  health  of  the  mother  so  constantly 
and  directly  refers  to  the  health  and  life  of  the  fcetus  that  it 
must  necessarily  follow  that  the  hygiene  of  pregnancy  will 

1  Gynecological  Transactions,  vol.  x.  p.  8. 


250  ESSAYS  AND  ADDRESSES. 

comprelieud,  to  a  certain  extent,  the  hygiene  o£  the  foetus  ;  but 
only  so  far  does  it  relate  to  the  diseases  of  intrauterine  life. 

The  changes,  consequent  upon  pregnancy,  which  take  place 
in  the  general  organism,  glandular  system,  and  generative 
organs  are  physiological.  Pregnancy  is  not  a  disease,  yet 
the  laws  of  diagnosis  have,  as  yet,  failed  to  define  the  limits 
where  the  physiological  ceases  and  the  pathological  begins. 
The  structural  changes  and  formative  activity  establish  con- 
ditions susceptible  of  easy  and  sometimes  rapid  and  insidious 
transformation  into  morbid  process.  They  invite  and  present 
the  opportunity  for  the  detrimental  influence  of  trivial  and 
extraneous  agencies.  It  is  not,  therefore,  surprising  that  the 
acquired  causes  of  the  diseases  of  pregnancy  should  be  so 
numerous  and  multifarious. 

The  virgin  uterus  measures  but  sixteen  square  inches  in 
superficial  area;  the  pregnant  womb,  at  term,  three  hundred 
and  forty.  The  textural  changes  which  take  place  involve 
every  constituent  tissue  of  the  organ.  The  constantly  increas- 
ing superficial  area,  weight,  and  dimensions  of  the  pregnant 
womb  take  place  in  a  cavity  supposed  in  a  normal  condition 
to  be  always  full.  This  cavity  is  enclosed,  for  the  greater 
part,  with  walls  possessing  great  expansile  and  elastic  proper- 
ties; nevertheless,  especially  in  primiparse,  the  mechanical  dis- 
turbances of  its  contents  are  manifold  and,  oftentimes,  seri- 
ous. The  cavity  is  filled  to  repletion  and  its  walls  stretched 
to  their  utmost  tension.  The  neighboring  viscera  are  displaced 
and  compressed.  The  movements  of  respiration  are  inter- 
rupted. The  thorax  is  diminished  in  depth  and  increased  in 
breadth.  Vital  capacity  is  lessened.  The  portal  circulation 
is  disturbed.  The  arterial  and  venous  blood-currents  in  the 
vessels  in  the  abdominal  cavity  and  lower  extremities  are  ob- 
structed ;  as  a  consequence  there  are  '  '■  superior  arterial  hyper- 
semia  and  inferior  venous  hypersemia  "  (Barnes).  Thus  local 
congestions  may  be  determined.  The  complex  processes  of 
digestion,  nutrition,  and  elimination,  in  some  one  or  more 
respects,    may    be   impeded,    impaired    or   perverted.      The 


ESSAYS  AND  ADDRESSES.  251 

peristaltic  iiiovcnujiits  of  tli<',  iiitcHtinul  Uwvi  aro  h«  ooii.stantly 
le.ssGiicd  with  the  increasing  volume  of  the  uterus  that  consti- 
pation, more  0H|)('cia,lly  diirini^  the  latter  months  of  pregnancy, 
is  a  common  and  trotihlesome  complication.  In  conwiqiience 
of  the  diminished  capacity  of  the  bladder  micturition  is  more 
frequent  and  annoying.  These  diHtiirbances  of  the  functions 
of  the  organs  and  aiiatomif^al  relations  of  the  parts,  caused  by 
the  presence  and  (U)iitlnuous  growtli  of  a  vascidar  and  highly 
organized  tumor  in  a  closed  cavity,  lined  by  an  acutely  sensi- 
tive membrane,  stretched  in  various  parts  to  its  utmf)st  tension, 
would  seem  to  present  a  variety  of  conditions  favorable  to  the 
development  of  disease.  This  danger  is  vastly  augmented 
by  the  constantly  increasing  afflux  of  blood  to,  and  the  exal- 
tation of  nutritive  and  formative  activities  in,  the  uterus  and 
genitalia. 

The  changes  which  take  place  in  the  constitution  of  the 
blood  approach,  even  more  closely,  pathological  conditions. 
The  red  corpuscles,  albumin,  iron,  and  salts  are  diminished. 
The  white  corpuscles,  fibrin,  and  water  are  increased.  With 
the  increase  in  volume  there  are  increasing  impoverishment  of 
the  blood  and  loss  of  the  carriers  of  oxygen.  Consumption 
and  waste,  and  elimination  of  carbonic  acid  and  urea  are  aug- 
mented with  diminished  ingestion  and  assimilation  of  food. 
Cell-nutrition  and  metamorphosis  are  consequently  deranged. 
With  the  increase  of  water  and  fibrin  and  loss  of  albumin,  a 
condition  of  serous  plethora  and  hyperinosis  is  established, 
which  favors  transudation,  coagulation,  and  thrombosis. 

Not  less  important  are  the  dynamic  changes  in  the  circula- 
tion. With  hypertrophy  of  the  heart  there  are  dilatation  of 
its  cavities  and  increased  arterial  tension.  It  may  be  that 
these  dynamic  changes  are  compensatory  and  not  resultant. 
They  coexist  with  lessened  vital  capacity,  diminished  oxy- 
genation, increased  blood-mass,  blood-degradation,  and  hyper- 
inosis, with  increased  liability  to  coagulation. 

The  I'lood  and  circulatory  changes  begin  and  progress  con- 
sentaneously with  the  nutritive  and  developmental  processes 


252  ESSAYS  AND  ADDRESSES. 

taking  place  in  the  generative  organs.  With  the  rapid  growth 
and  increasing  demand  of  the  new  being  for  sustenance  there 
is  progressiv^e  waste  with  lessened  food-supply.  AVith  the 
augmentation  of  blood-mass  there  are  anaemia,  diminished 
oxygenation,  and  increased  propulsive  power  of  the  circula- 
tory apparatus. 

The  changes  which  take  place  in  the  glandular  system  are 
equally  interesting  and  no  less  remarkable.  Probably  all  the 
glands  undergo  some  change,  due,  perhaps,  to  the  increased 
work  imposed  upon  them.  The  thyroid  gland  and  spleen  are 
usually  enlarged,  the  latter  sometimes  very  much  so.  The 
thyroid  enlargement  may  have  some  connection  with  the 
hypertrophy  of  the  heart  and  increased  arterial  tension.  The 
condition  of  the  spleen  would  seem  to  be  directly  connected 
with  the  blood-changes.  They  may  be  conservative  processes, 
but  are  closely  allied  to  certain  pathological  conditions. 

The  most  notable  gland-changes  are  those  which  occur  in 
the  secretory  and  excretory  glands.  The  salivary  glands,  the 
glands  of  the  uterine  neck,  the  sebaceous  and  sudoriparous 
glands,  and  those  of  the  stomach,  all,  to  a  greater  or  less  ex- 
tent, varying  with  individual  peculiarities  and  susceptibilities, 
undergo  functional  and  organic  change.  These  modifications 
of  gland  structure  and  function  may  be  the  physiological  out- 
growths of  the  circulatory  disturbances,  increased  nerve-irri- 
tability, and  extraordinary  activity  of  the  nutritive  energies. 
Turgescence  is  a  common  factor,  and  increased  secretion  a 
common  result.  They  are  probably  eliminative  and  compen- 
satory conditions,  but  why  should  they  vary  so  much  in  differ- 
ent women,  and  in  the  succeeding  pregnancies  of  the  same 
woman  without  apparent  cause  ?  As  a  rule,  the  increased 
secretions  are  simply  the  physiological  result  of  glandular 
activity.  Excessive  salivation,  uterine  hydrorrhoea,  and  the 
vomiting  of  unusual  quantities  of  fluid  must,  however,  be 
considered  pathological. 

The  changes  which  take  place  in  the  mammary  glands 
are  developmental.     Milk  is  the  natural  aliment  of  young 


ESS  A  YS  A  Nl>  A  I)  DRESSES.  263 

jiiiiriiiils.  Maternal  lactation  ih  tin;  naliiral  inrflifKl  of  Hiipjily- 
injr  it  to  the  infant.  The  secretion  of  mili<  i.s  iIk-  ultimate 
])ro(lii(;t  of  those  (•.JKin'^cH  in  thcsf;  jrlandH  whirh  begin  with 
|)reji;Mancy  and  are  coniplcted  during  the  earlier  (hiy»  of  the 
puerperium.  Lactation  begins  with  the  birth  of  the  offspring, 
nnd  continues  for  an  ind(,'(init(!  p(!riod.  The  function  is  not 
suddenly  estahlisiied,  nor  does  it  suddenly  subside.  The 
periodical  evolution  of  the  breasts  corresponds  with  the  pro- 
gress of  pregnancy.  Both  processes  are  gradual.  The  grad- 
ual subsidence  and  cessation  of  the  function  of  ra  ilk-secret  ion 
siiould  correspond  with  the  gradual  involution  of  the  gland- 
structure  and  its  return  to  a  state  of  quiescence  and  dimin- 
ished size.  With  the  recurrence  of  pregnancy  the  process  of 
evolution  and  functional  activity  is  reawakened.  No  other 
organs  of  the  body,  except  the  uterus  and  ovaries,  are  .sub- 
jected to  similar  periodical  changes.  As  the  uterus  and  ovaries, 
so  likewise  the  mammary  glands,  when  the  period  of  sexual 
involution  begins,  undergo  those  changes  which  finally  termi- 
nate glandular  activity.  The  processes  of  periodical  evolu- 
tion and  involution  are  in  inverted  parallelism.  The  former 
is  as  necessary  to  promote  the  secretion  of  milk  as  the  latter 
is  to  restore  the  gland  to  a  normal  quiescent  condition,  to 
await  rehabilitation  and  renewed  functional  activity  with  suc- 
ceeding pregnancy.  To  the  functional  irregularities  and 
derangements  caused  by  artificial  interference  with  these  phys- 
iological processes  must  be  traced  many  of  the  tumor  diseases 
to  which  these  glands  are  so  liable. 

Several  years  ago,  when  engaged  in  the  study  of  the  dis- 
eases of  the  lymphatic  system,  I  suggested  that  the  cicatrices 
and  pigmentations  of  pregnancy  were  due  to  disturbances  of 
the  lymph-spaces.  Subsequently  I  demonstrated  that  the 
cicatrices  were  dilated  lymph-spaces  of  the  corium.  Since 
then  Creightou  has  verified  my  suggestion  in  regard  to  pig- 
mentation. These  pigmentations  are  due  to  the  deposition 
in  the  lymph-spaces  and  other  lymph-structures  of  the  waste 
products  of  evolution.     The  discoloration  of  the  areolae  of 


254  ESSAYS  AND  ADDRESSES. 

mammary  glaads  is  one  of  the  earliest  signs  of  the  evolution, 
and  the  latest  to  disappear  in  the  involution  of  the  glands. 
It  is  the  result  of  the  deposit  of  pigment-granules  in  the  con- 
nective-tissue spaces.  Granular  pigmented  cells  are  also  found 
within  the  secretory  acini  and  in  the  lymph-spaces  of  the  sub- 
jacent lymphatic  glands.  The  pigmentations  in  other  locali- 
ties are,  probably,  similar  depositions  of  the  waste-products 
of  tissue-changes  taking  place  in  adjacent  and  neighboring 
parts. 

The  lymphatic  structures  of  the  mammae  are  essential  ap- 
pendages of  the  secretory  apparatus  of  the  glands  ;  and  in  the 
breasts,  as  elsewhere  throughout  the  body,  are  the  receptacle 
of  the  redundant  elements  and  products  of  nutrition.  The 
absorption  and  disposal  of  these  products  and  their  elimina- 
tion and  utilization  are  the  special  functions  of  the  lymphatic 
system.     These  processes  are  very  active  during  pregnancy. 

Physiological  leucocytosis  is  one  of  the  characteristic  phe 
nomena  of  pregnancy.  Virchow  was  the  first  to  call  atten- 
tion to  the  fact  that  these  periodical  excesses  of  white  corpus- 
cles in  the  blood  were  not  due  to  changes  taking  place  in  the 
blood  itself.  They  are  mainly  the  product  of  irritation  of 
the  lymphatic  glands.  He  says  :  ''In  proportion  as  preg- 
nancy advances,  as  the  lymphatic  vessels  of  the  uterus  dilate, 
and  the  interchange  of  material  in  the  organ  increases  with 
development  of  the  foetus,  the  lymphatic  glands  in  the  inguinal 
and  lumbar  regions  become  enlarged,  and  sometimes  to  such 
an  extent  that,  if  we  were  to  find  them  in  a  similar  state  at 
any  other  time,  we  should  regard  them  as  inflamed.  This 
enlargement  conveys  into  the  blood  an  increased  quantity  of 
fresh  particles  of  a  cellular  nature,  and  thus  from  month  to 
month  the  number  of  colorless  corpuscles  augments."  The 
lymphatic  structures  of  the  pelvic  region  must  be  the  chief 
source  of  the  leucocytosis  of  pregnancy ;  but  with  Creighton 
we  "  must  believe  that  the  abundant  cellular  waste-products 
of  the  breasts  contribute  to  that  condition." 

The   disposal   and  utilization    of  the   unused   and   waste 


I'JSSA  )'S  AND  AI)!)ni':sSKS.  2.bb 

products  of  secretion  are  pari  of  tlu;  niarvclloiis  j)li('iiorii(ri,'i  of 
])r(!<^iian(;y.  Tlic  lymphatic  HyHt<!m  i.s  tiie  laboratory  in  wliif;li 
tli(!se  mateiials  arc  rcpniparcd  for  future  nutrition.  The 
incrcaHcd  burden  iniposcsd  upon  it  excites  new  and  auj^inented 
activities.  It  seems  to  occupy  the  relation  of  an  intermediary, 
comph'lino;  the;  physioloifinal  process  and  protcotinj^  the  organ- 
ism from  pathological  conditions.  ]>iit  as  organs  of  reception, 
filtration,  elaboration,  and  conveyance,  the  lymph-glands  and 
structiu'es  may  become  foci  for  the  generation  and  diffusion 
of  disease. 

The  liver  and  kidney  have  increased  work  to  do  during 
pregnancy.  Trousseau  and  several  other  observers  have  in- 
sisted that  the  liver  was  enlarged.  It  supplies  the  bile,  which 
is  an  essential  element  of  digestion.  It  is  also  an  excremental 
organ,  insomuch  as  it  receives  the  blood  from  the  portal  sys- 
tem which  is  charged,  in  a  part  at  least,  with  the  products  of 
augmented  blood-supply  to  the  pelvic  organs  and  of  the  enor- 
mous developmental  work  which  takes  place  in  that  region. 
The  portal  blood  must  be  loaded  with  these  excremental  mat- 
ters, and  greatly  increased  duty  must,  consequently,  be  imposed 
upon  the  liver.  As  an  emunctory,  the  liver  is  usually  equal 
to  the  emergency  ;  but  this  function  must  be  supplemented  by 
the  increased  eliminative  capacities  of  the  skin,  lungs,  and 
kidneys.  In  health  these  organs  preserve  their  compensatory 
activities,  but  ineffective  power  in  either  may  lead  to  accumu- 
lations in  the  blood  which  will  poison  the  entire  organism  and 
produce  disastrous  results.  The  lungs  eliminate  carbonic  acid  ; 
the  skin  dissipates  animal  heat,  and  excretes  water,  urea,  and 
salts  ;  but  the  kidneys  are  the  chief  emunctory  glands.  Upon 
them  devolves  mainly  the  elimination  of  the  useless  and  pois- 
onous products  of  secretion  and  tissue-change.  They  have  no 
reeremeutitial  function  to  execute.  Through  them  the  waste 
is  finally  discharged.  This  office  is  a  relentless  necessity. 
The  compensatory  organs  are  absolutely  inadequate  to  assume 
the  duty  and  maintain  health.  During  pregnancy  the  work 
is  vastly  increased,  and  a  larger  quantity  of  abnormal  elements 


256  ESSAYS  AND  ADDRESSES. 

find  their  way  into  the  urine.  With  the  progress  of  utero- 
gestation  the  more  urgent  is  renal  elimination,  and  the  more 
imminent  the  danger  of  disturbance  of  the  function. 

I  need  not  now  detain  the  reader  with  a  recital  of  the  path- 
ological phenomena  of  the  albuminuria  of  pregnancy ;  but  I 
cannot  permit  the  occasion  to  pass  without  impressing  upon 
him  the  importance  of  early  recognition  of  the  initial  sign  of 
its  presence.  I  have  more  than  once  expressed  the  opinion 
that  puerperal  eclampsia  and  its  lamentable  consequences  were 
too  often  attributable  to  neglect.  I  hold  that  the  pregnant 
woman  should  be  under  continuous  observation  of  a  competent 
physician ;  and  when  such  is  the  case,  he  is  responsible  for 
the  occurrence  of  avoidable  disease.  I  believe,  furthermore, 
that  if  such  observation  were  diligently  and  intelligently  pur- 
sued, the  cases  of  eclampsia  would  be  greatly  diminished,  and 
the  mortality  would  be  reduced  to  its  minimum. 

I  venture  to  call  attention  to  another  circumstance  too  often 
forgotten.  More  women  die  of  renal  disease  during  the  period 
of  child  bearing  life  than  men  of  the  same  age.  The  ordinary 
result  of  complete  recovery  from  puerperal  nephritis  after 
delivery  is  too  often  accepted  as  inevitable,  and  the  patient  is 
discharged  without  even  an  admonition  of  the  peril  which 
may  hasten  her  untimely  death. 

I  will  remind  you  also  of  the  physiological  relationship 
and  reciprocal  dependency  of  the  excretory  functions  of  the 
lungs,  skin,  intestinal  tract,  and  kidneys.  Disturbance  of  this 
close  connection  may  speedily  develop  grave  disorder. 

Until  recently,  the  appearance  of  albumin  in  the  urine  was 
universally  held  to  be  the  symptom  of  threatening  danger, 
notwithstanding  the  facts  that  in  very  many  cases  no  grave 
complications  occurred ;  and  in  many  other  cases,  even 
when  the  symptoms  denoted  serious  lesions  of  the  kidneys, 
all  traces  of  disease  speedily  and  spontaneously  subsided 
after  the  evacuation  of  the  uterus.  There  can  no  longer  be 
any  doubt  that  albumin  does  appear  in  the  urine  during 
health  as  a  physiological  phenomenon ;  but  whether  such  a 


Yi'-V.SVl  y.S  A  M)  A  1)1)11 1'JSSI'JS.  2  f)  7 

condition  iH  ovor  ])r(!.s(!iit  (liinii*^   prcfriiaiu-y  is  yt  a   iiH)o1f;<l 
question. 

Physiological  albuminuria  has  hcon  ascribed  to  various 
causes.  The  presence  of  albumin  in  the  urine  of  the;  new- 
born has  been  attril)uted,  by  Jtil)bert,  to  the  protoplasmic 
condition  of  the  cells  of  the  glomeruli ;  by  Roscnbach,  to 
su]>erHuous  albumin  in  the  blood,  due  to  too  rapid  disinte- 
gration of  blood-corpuscles;  and,  by  Senator,  to  the  increased 
vascular  pressure  in  the  glomeruli  coincident  with  increased 
loss  of  water  through  the  skin  and  lungs  and  disintegration 
of  blood-corpuscles.  In  the  urine  of  the  healthy  adolescent 
it  is  ascribed  to  rapid  growth  and  development ;  and  in  the 
urine  of  healthy  adults,  to  excessive  muscular  activity,  the 
ingestion  and  digestion  of  highly  albuminous  foods,  mental 
excitement,  and  cold  bathing.  Does  the  state  of  pregnancy 
present  any  conditions  analogous  to  these  alleged  causes  of 
physiological  albuminuria  occurring  in  males  and  non-preg- 
nant persons?  If  so,  why  should  not  a  similar  result  follow? 
It  may  be  straining  facts  too  far  to  insist  that  the  increased 
arterial  tension,  the  blood-degradation,  the  rapid  growth  and 
development,  the  mental  disquietude,  the  augmented  cutaneous 
and  pulmonary  exhalations,  and  auisraia  of  pregnancy  are  phe- 
nomena similar  to  those  present  in  otherwise  healthy  infants, 
adolescents,  and  adults,  in  whose  urine  albumin  may  be  found; 
but  the  conclusion  will  not  appear  so  overdrawn  when  to 
those  conditions  may  be  added  the  probable  disturbance  of  the 
functions  of  the  liver,  the  almost  constant  presence  of  alimen- 
tary and  nervous  perturbations,  and  possible  ingestion  of  an 
excessive  quantity  of  highly  albuminous  foods,  which  are 
occasional  factors  in  the  causation  of  albuminuria.  Special 
mention  is  made  of  cold  bathing  as  a  cause  of  physiological 
albuminuria.  May  not  sudden  chilling  of  the  cutaneous  sur- 
face, rapid  dissipation  of  heat,  and  consequent  determination 
of  chilled  blood  to  the  internal  organs  be  an  equally  effective 
agency,  when  the  result  of  imprudent  exposures  and  insuffi- 
cient clothing  ?    Cold  bathing,  though  a  frequent,  is  not  such  a 

17 


258  ESSAYS  AND  ADDRESSES. 

common  practice  among  pregnant  women  as  other  indiscreet 
exposures  of  the  person  to  chilling  influences. 

Pregnancy  exhibits  during  its  progress  many  other  phenom- 
ena not  unlike  those  frequently  associated  with  albuminuria 
in  non-pregnant  persons,  and  believed  to  be  active  agencies  in 
the  causation  of  such  pathological  conditions.  The  most  com- 
mon immediate  cause  of  puerperal  albuminuria,  and  perhaps 
an  equall}^  frequent  cause  in  the  non-pregnant,  is  the  increased 
tension  of  blood  in  the  glomeruli,  either  from  increased  affer- 
ent pressure  or  undue  efferent  resistance.  The  arterial  tension 
of  pregnancy  finds  its  causes  in  the  enlarged  left  ventricle, 
greater  blood-mass,  blood-degradation,  disturbances  of  the  ex- 
cretory organs,  especially  of  the  skin  and  bowels,  and  de- 
rangements of  the  nervous  system,  either  local,  general,  or 
reflex.  The  efferent  resistance  may  be  either  capillary  or 
venous,  and  may  be  due  to  functional  or  mechanical  condi- 
tions. If,  then,  these  phenomena  are  physiological  in  the 
pregnant  female  and  pathological  in  the  non-pregnant,  and 
in  each  instance  stand  in  like  etiological  relation  to  albumi- 
nuria, must  the  appearance  of  albumin  in  the  urine  differen- 
tiate an  abnormal  from  a  normal  pregnancy  ?  Experience 
tells  us  that  in  many  cases  of  pregnancy  very  large  quantities 
of  albumin  appear  in  the  urine  without  the  occurrence  of 
any  serious  complication,  and  that  it  usually  disappears  after 
delivery,  and  sometimes  after  the  death  of  the  foetus  in  utero. 
It  may  be  physiological  in  a  few,  functional  in  many  more ; 
but  we  must  in  the  future,  as  in  the  past,  continue  to  regard 
it  as  pathological  in  the  majority  of  cases,  and  as  a  danger- 
signal  of  the  gravest  importance. 

With  this  ensemble  of  physiological  conditions  and  patho- 
logical possibilities,  do  you  marvel  that  some  pregnant  women 
get  sick  and  a  number  die  ?  It  is  no  answer  to  tell  me  that 
the  ailments  and  mortality  of  pregnancy  are  incidents  of  edu- 
cation and  civilization.  If  so,  the  most  effective  method  of 
hygiene  would  be  the  relegation  of  every  pregnant  woman  to 
besotted  ignorance,  barbarism,  and  beastliness — a  remedy  more 


ESS  A  YS  A  N  I)  A  DDR  ESSES.  259 

rCvoltinj^  than  "  Voii-doo"  iiialiciiio,  wliicli  traf;(;,s  cauHc  and 
effect  and  diHease  and  recovery  to  stupid,  diHgimting,  and 
criminal  superstitions.  In  view  of  the  facts  that  among  civ- 
ilized people  the  average  lifetime  is  greater,  the  mortality 
of  the  lying-in  is  less,  and  mtjre  women  live  out  the  a]]«;tt(:d 
lifetime  now  than  during  any  previous  period  of  medical  his- 
tory, I  repudiate  any  analogy  derived  from  the  customs, 
habits,  practices,  and  their  results  among  nomadic,  aljoriginal, 
and  barbaric  races  and  peoples.  With  the  progressive  im- 
provements in  the  conduct  and  management  of  the  pregnant 
and  puerj)eral  states  tiie  expectancy  of  life  and  longevity  of 
the  post-cessation  life  have  increased. 

The  hygiene  of  pregnancy  demands  an  acuteness  and  accu- 
racy of  diagnosis  not  always  or  easily  acquired.  The  physio- 
logical so  frequently  approaches  the  pathological  that  differen- 
tiation of  disease  is  involved  in  embarrassing  obscurity.  The 
insidious  beginning  of  morbid  processes  is  often  so  ill-defined 
and  the  consequences  of  delay  are  so  disastrous  that  the  ac- 
coucheur cannot  afford  to  abide  the  issue  of  complete  devel- 
opment when  the  diagnosis  is  plainly  written  in  the  picture 
of  a  grave  disorder  threatening  immediate  danger.  He  must 
be  alert,  accurate,  ready,  and  self-reliant. 

The  present  occasion  does  not  permit  me  to  engage  in  a 
detailed  description  of  the  special  disorders  of  pregnancy.  I 
must  assume  that  you  are  quite  as  competent  as  I  am  to  recog- 
nize and  treat  such  diseases.  But,  following  the  line  of  argu- 
ment previously  pursued,  I  must  insist  that  the  most  effective 
method  of  prevention  of  the  complications  of  pregnancy  con- 
sists in  the  preservation  of  the  normal  functional  activities  of 
the  excretory  and  emuuctory  organs. 

The  constant  and  necessary  physiological  relation  subsisting 
between  the  skin,  lungs,  alimentary  tract,  and  kidneys  de- 
mands vigilant  supervision.  Constipation  should  be  relieved. 
No  fecal  mass  should  be  allowed  to  accumulate  in  the  intes- 
tines. The  bowels  should  be  kept  in  a  solvent  condition  and 
an  evacuation  should  be  secured  very  day,  either  by  regulating 


260  ESSAYS  AND  ADDRESSES. 

the  diet  aud  habits  of  the  patient  or  by  such  mild,  but  suffi- 
ciently effective  therapeutic  agents  as  a  skilled  discretion  may 
suggest. 

It  often  happens  that  patients  deceive  themselves  by  inat- 
tention, and  their  medical  attendant  either  by  evasive  or  exag- 
gerated statements  concerning  the  state  of  their  bowels.  As 
a  rule,  one  can  verify  or  not,  as  the  case  may  be,  such  state- 
ments by  an  examination  of  the  tongue  aud  conjunctivae,  by 
malodor  of  the  breath  aud  person,  aud  by  inquiries  in  regard 
to  the  condition  of  the  stomach,  appetite,  aud  digestion,  the 
nature  and  quantity  of  food,  when  and  how  often  taken,  and 
whether  the  ingestion  of  food  and  drinks  is  accompanied  or 
associated  with  any  sense  of  fulness,  discomfort,  flatulence,  or 
acidity.  jSTot  only  will  a  careful  investigation  detect  the  exist- 
ence of  habitual  constipation  when  a  positive  assurance  to  the 
contrary  has  been  given,  but  it  may  disclose  the  cause,  and 
indicate  at  once  the  method  of  treatment. 

The  inspection  of  exposed  cutaneous  surfaces  will  be  greatly 
aided  by  palpation.  Cleanliness  of  the  skin  and  the  free 
functional  activity  of  the  sebaceous  and  sudoriparous  glands 
must  be  secured  by  necessary  tepid  or  hot  ablutions  or  bath- 
ing. Cold  bathing  is  not  always  safe.  The  drinkiug  of 
large  and  unnecessary  quantities  of  liquids — an  injurious 
habit  with  very  many  people — imposes  augmented  labor  upon 
those  organs  charged  with  the  exhalation  of  fluid.  Excessive 
micturition  and  profuse  sweating  are  occasionally  annoying 
results  of  the  excessive  consumption  of  liquids. 

The  respiration  may  be  embarrassed  by  the  mechanical 
repletion  of  the  abdominal  cavity  and  by  the  altered  contour 
of  the  thorax,  which  are  unavoidable  conditions.  This  discom- 
fort may  be  greatly  aggravated  by  flatulent  distention  and 
overloading  of  the  alimentary  tract,  due  to  the  ingestion  of 
acescent  and  unsuitable  foods,  and  to  constipation  before 
referred  to.  A  more  significant  disturbance  of  the  respiration 
may  result  from  the  blood-degradation  and  anaemia. 

The  constituent  and  dynamic  changes  in  the  circulation 


f'JSSA  YS  A  Nl>  A  I)  DHKSSICS.  2  0 1 

more  often,  |)(M'1i;i|),s,  puHH  tho  j)IiyHi()I();i;i<-iil  limit  than  any 
other  of  the  phenonKsnu  of  pre;^naney.  The  hhtorl  i.s  a  fliiirl 
tissue.  Into  it  are  poitred  (Osier)  the;  ooinmoditioH  neefUd 
for  nntrition,an(l  from  it  th(;  other  tissues  (IcH'ivc  the  materials 
they  recpiire.  Notwithstandin}^  the  ceaseless  chanjjje  and  ex- 
change which  go  on,  a  uniformity  of  composition  is  one  of  the 
striking  clKunuiteristics  of  b(!altii.  The  l)loocl-j)lasma  is  sup- 
posed to  supply  nutriment  to  the  tissues,  and  the  red  bloofl- 
corpuscles  are  the  carriers  of  oxygen  and  carbonic  acid.  In 
pregnancy  the  former  is  greatly  diluted,  and  the  latter  greatly 
diminished  in  number.  When  these  clianges  pass  the  limit 
of  health  the  consequences  are  numerous  and  may  be  serious. 
Cell-nutrition  is  interrupted ;  formative  activity  is  lessened  ; 
the  metabolism  of  tissues  is  disturbed  ;  waste  increases,  fol- 
lowed by  impaired  appetite,  enfeebled  digestion,  loss  of  phys- 
ical vigor,  increased  nerve-irritability,  altered  and  diminished 
excretion  and  secretion,  with  occasional  cerebral  and  intellec- 
tual disturbances.  These  conditions  may  be  associated  with 
some  one  or  more  of  a  variety  of  resultant  nervous  perturba- 
tions, or  other  not  uncommon  disorder  of  pregnancy.  The  anae- 
mia of  pregnancy  is,  to  a  greater  or  less  degree,  always  present. 
As  an  element  of  causation  in  the  production  of  the  diseases 
of  pregnancy  it  cannot  be  excluded,  and  must  be  accepted  as 
the  most  constant  and  potential  factor.  To  it,  and  to  the 
mechanical  disturbances  of  the  abdominal  viscera,  and  inter- 
ference with  the  function  of  respiration,  we  must  look  for  the 
causes  of  most  of  the  morbid  complications  of  pregnancy. 
When  this  anaemia  has  reached  a  high  grade  its  ravages  are 
not  easily  arrested  during  the  continuance  of  pregnancy.  Our 
best  and  most  successful  efforts  never  free  us  from  the  appre- 
hension of  recurring  danger.  Prevention  is  the  sheet-anchor. 
To  accomplish  this  effectively  a  vigilant  supervision  of  the 
patient  is  imperative.  The  diet  must  be  regulated  and  adapted 
to  existing  circumstances  ;  disturbances  of  the  alimentary  tract 
must  be  obviated ;  the  excretory  and  eliminative  functions 
must  be  protected;  sufficient  sleep  must  be  secured  ;  all  sources 


262  ESSAYS  AND  ADDRESSES. 

aad  causes  of  anxiety,  irritation,  and  excitement  must  be 
removed ;  and  last,  though  not  the  least  important,  exercise 
in  the  open  air  must  be  insisted  upon.  To  these  hygienic 
measures  such  therapeutic  treatment  should  be  added  as  intel- 
ligent experience  and  observation  have  proved  to  be  useful. 

The  hygiene  of  person  should  be  supplemented  with  the 
hygiene  of  habitation  and  sleeping-apartments.  A  large, 
dry,  well-ventilated  and  well-lighted  room,  above  the  ground- 
floor,  should  be  selected  for  the  sleeping-apartment,  and  this 
should  be  in  a  dwelling  equally  faultless  in  regard  to  ventila- 
tion, dryness,  sunlight,  and  freedom  from  noxious  effluvia 
and  sewer  or  deleterious  exhalations.  As  pregnancy  advances 
the  clothing  should  be  adapted  to  the  changes  in  contour  and 
form ;  all  tightly  fitting  garments,  stays,  garters,  and  other 
uncomfortable  appendages  should  be  either  entirely  dispensed 
with  or  so  adjusted  as  to  remove  unequal  pressure  and  avoid 
the  constriction  of  parts. 

In  conclusion,  a  few  words  personal  to  myself.  This  meet- 
ing terminates  the  third  year  of  the  existence  of  this  Society 
and  closes  the  third  term  of  my  presidency.  I  have  endeav- 
ored to  discharge  the  duties  of  this  office  with  impartiality. 
If  mistakes  have  been  committed,  do  me  the  favor  to  ascribe 
them  to  errors  of  judgment.  I  could  not  expect  to  enjoy  this 
honor  any  longer,  nor  would  it  be  just  to  other  members 
equally  if  not  more  deserving  and  competent.  Accept  my 
thanks  for  the  honors  you  have  conferred  upon  and  the  con- 
fidence you  have  reposed  in  me,  and  believe  that  it  will  give 
me  great  pleasure  to  welcome  your  choice  as  my  successor  to 
these  duties  and  this  high  honor.  I  wish  each  one  and  all 
of  you  health  and  long  and  prosperous  lives. 


ESS  A  YS  AND  A  l>  Dli  hlSSES.  263 


ADDRESS   OF   WELCOME 

DELIVERED   TO   TirE   (JONGRE8S   OF   AMERICAN    PHYSICIANS 
AND  SURGEONS  AT  WASHINGTON,  SEPTEMBER  18,  1888. 

Mr.  President  and  Gentlemen  :  lu  behalf  of  the  Com- 
mittee of  Arrangements,  and  of  the  profession  and  citizens  of 
this  city,  I  bid  you  welcome. 

The  circumstance  of  the  simultaneous  assemblage  here  to- 
day of  the  special  medical  societies  of  this  country  will  mark 
an  epoch  in  the  history  of  the  American  medical  profession 
which  must  redound  to  its  honor  and  renown.  In  the  fact 
that  it  brings  together  at  the  same  time  and  place  those  bodies 
of  men  which  hold  in  their  membership  so  many  who  have 
devoted  their  lives  and  energies  to  the  study  and  development 
of  special  branches  of  medical  science,  and  have  won  by  their 
work  pre-eminence  as  skilled  physicians  and  surgeons,  in  an 
organization  that  offers  the  unusual  opportunity,  by  systematic 
arrangement,  for  the  consideration,  by  specialists  equally  dis- 
tinguished in  different  branches,  of  subjects  as  yet  unsettled 
but  of  general  medical  interest,  it  is,  perhaps,  the  most  remark- 
able concourse  of  medical  men  that  has  ever  assembled  in  this 
country.  While  it  sets  forth  conspicuously  this  distinctive 
feature,  it  in  no  manner  interferes  with  the  autonomy  of  the 
constituent  societies,  each  of  which  pursues  its  chosen  method 
according  to  its  own  plan  of  organization. 

It  utters  no  word  in  derogation  of  organized  effort  through 
allied  associations  ;  nor  does  it  directly  or  by  implication  seek 
to  control,  direct,  or  influence  the  business  aspects  of  the  pro- 
fession ;  but  devotes  tliought  and  act  solely  aud  exclusively 
to  the  advancement  of  the  science  of  medicine.  With  such  a 
purpose  in  view  no  apology  is  needed  for  your  presence  here. 

The  gratification  it  gives  me  to  welcome  you  is  enhanced  by 
the  presence  of  the  distinguished  men  from  other  countries, 


264  ESSAYS  AND  ADDRESSES. 

who  have  come  to  honor  and  encourage  us,  and  to  make 
"  assurance  doubly  sure  "  that  the  promise  to  contribute  some- 
tbino;  to  the  common  fund  of  knowledo-e  will  be  fulfilled. 

I  welcome  you  also  as  a  citizen  of  the  city  located  by  Wash- 
ington and  planned  by  L'Enfant,  under  his  supervision,  which 
has  grown  during  the  first  century  of  its  existence  into  a  city 
surpassing  in  beauty  and  rivalling  iu  attractiveness  the  more 
favored  and  older  cities  of  both  the  old  and  new  worlds.  A  city 
representing  in  its  population  sixty  millions  of  free  people 
inhabiting  a  domain  stretching  across  a  continent  from  ocean  to 
ocean  and  from  the  frigid  north,  where  the  summer  solstice 
finds  the  earth  buried  in  suow  and  ice,  to  the  evergreen  and 
tropical  south.  A  city  holding  together  in  one  compact  com- 
munity a  cosmopolitan  population  where  education  and  culture 
need  neither  the  blazonry  of  titular  insignia,  the  heraldry  of 
ancestral  distinction,  nor  the  glamour  of  wealth  to  command 
position  and  influence.  Where  the  lady  and  gentleman  can 
always  find  congenial  and  cultivated  companionship  free  from 
the  conventional  and  exclusive  formalities  which  disrupt 
society  into  graded  coteries  of  self-constituted  notables.  A 
city  which  you  will  not  be  surprised  to  find  has  attracted  the 
cultivated  and  leisure  classes  from  every  State  and  city  in 
the  Union. 

I  welcome  you  also  as  a  citizen  of  the  National  Capital, 
richly  endowed  by  a  munificent  government  with  foundations, 
not  as  yet  complete  iu  any  department,  but  steadily  progress- 
ing; toward  that  standard  of  excellence  and  usefulness  which 
will,  in  the  near  future,  make  the  political  home  of  the  nation 
the  centre  of  science,  literature,  and  art. 

I  need  hardly  tell  you,  gentlemen,  how  much  this  govern- 
ment has  done  for  our  profession.  You  know  of  the  Medical 
Library,  unequalled  in  volumes  and  value,  and  the  Medical 
Museum,  with  its  anatomical  and  biological  laboratories, 
unsurpassed  by  any  similar  collection  in  the  world,  both  now 
located  in  a  building  constructed  for  the  purpose,  and  so 
arranged  as  to  exhibit  their  extent  to  casual  inspection,  and 


I<:SSA  VS  AND  ADDIIESSRS.  2C5 

to  eiiliuiico  their  value  ("or  apju'opriate  and  availuljle  |)iir))OH(iH. 
In  connection  with  thin  niagriificent  h'hrary  the  |)iil)lication  of 
the  Index- Catalof/ue,  which  enables  the  investigator  to  stndy 
any  medical  siibj(u't  frotn  its  beginning  down  to  tiie  latest 
|)(ibli(!ation,  and  of  which  it  is  not  too  much  to  say  that  it 
will  (H)nlribute  naore  toward  the  higher  education  of  tiie  pro- 
fession than  any  single  act  of  any  nation  on  the  face  of  the 
globe.  And  all  this  has  been  accomiilisiied  in  the  lifetime  of 
one  man,  who  still  lives  to  prosecute  his  labors  with  that  dili- 
gence, lidelity,  and  pertinacity  which  mark  the  unselfish  and 
conscientious  enthusiast. 

Then,  too,  the  government  has  established,  in  connection 
with  the  Bureau  of  Naval  Medicine  and  Surgery,  a  Museum 
of  Hygiene,  which  offers  to  every  citizen  the  opportunity  to 
examine  and  study  the  relative  advantages  and  utility  of  every 
device  and  appliance  for  the  improvement  and  perfection  of 
the  hygiene  of  the  dwelling.  Under  the  fostering  care  of  a 
liberal  government  and  the  conscientious  discipline  of  the 
Naval  Bureau  of  Medicine  this  establishment  has  already 
become  an  important  adjunct  to  preventive  medicine,  and  will, 
without  doubt,  continue  to  grow  in  usefulness  both  to  the 
government  and  to  the  country  at  large. 

The  National  Quarantine  and  Marine-Hospital  Service  is 
another  establishment  which  allies  the  government  with  the 
medical  profession  and  brings  it  close  to  the  people  of  the 
country  in  its  beneficent  purpose  to  provide  for  the  sick  and 
disabled  sailors  of  the  merchant  and  revenue  marine,  and  to 
prevent  the  introduction  and  spread  of  contagious  diseases  into 
the  country  through  its  maritime  ports. 

It  may  be  that  the  government  required  these  establishments 
to  fulfil  its  delegated  functions,  and  is  compelled  to  secure 
the  services  of  skilled  medical  meu  to  superintend  their  proper 
administration  ;  nevertheless,  even  admitting  this  necessity  to 
be  the  primary  cause  for  their  creation,  it  in  no  manner  im- 
pairs their  value  to  the  profession,  and  their  foundation  im- 
poses upon  us  the  duty  to  utilize  them  for  the  common  good, 


266  ESSAYS  AND  ADDRESSES. 

and  invites  us  to  aid  to  develop  and  widen  the  scope  of  these 
endowments  to  the  end  that  we  and  the  people  may  realize 
the  full  measure  of  their  usefulness. 

The  Bureaus  of  Army  and  Navy  Surgery  are  also  located 
here.  It  is  true  they  are  corps,  constituting  important  and 
essential  parts  of  the  complete  equipment  of  the  military  estab- 
lishment of  the  nation.  They  are,  nevertheless,  the  instru- 
mentalities through  which  the  government  has  been  enabled 
to  call  into  its  service  medical  men  of  the  highest  order  of 
professional  attainments,  and  to  accomplish  so  much  in  pro- 
moting the  advancement  of  scientific  medicine. 

The  government  has  been  equally  generous  toward  other 
departments  of  science.  If  the  time  and  occasion  permitted, 
it  would  give  me  great  pleasure  to  lay  before  you,  in  detail, 
the  work  being  done  in  the  scientific  bureaus  established  and 
supported  by  the  general  government  in  this  city;  and,  also,  to 
refer  to  the  eleemosynary  and  educational  institutions  founded 
and  exclusively  supported  by  the  government,  as  well  as  others 
to  which  it  contributes  annually  a  liberal  though  partial  sup- 
port. I  must,  however,  be  content  with  the  bare  statement 
of  the  fact  that  you  may  carry  home  with  you  the  conviction 
which  I  wish  to  impress  upon  you,  in  behalf  of  our  city,  that 
by  virtue  of  the  foundations  and  endowments  of  the  govern- 
ment it  has  become  a  scientific  and  educational  centre  equal 
to  any  and  surpassing  most  of  the  older,  richer,  and  more 
populous  cities  of  the  country.  In  this  connection  I  cannot 
omit  reference  to  her  admirable  system  of  common  schools  and 
her  universities  :  that  of  Georgetown,  with  its  departments  of 
humanities,  philosophy,  and  science,  and  of  law  and  medicine; 
the  Columbian,  with  its  preparatory,  scientific,  law,  and  med- 
ical departments  ;  the  National,  limited,  as  yet,  to  law,  medi- 
cine, and  dentistry ;  the  Howard,  especially  devoted  to  the 
education  of  colored  citizens,  with  departments  of  literature, 
law,  medicine,  dentistry,  and  theology ;  and,  finally,  the  new 
Catholic,  now  in  course  of  organization  and  construction. 

To  all  this  let  me  add  the  Smithsonian  Institution  with  its 


JCSSA  VS  A  Nl>  A  DDIIICSHES.  2fJ7 

aniU!X(«  of  tli(!  Nalionnl  MiiHciitii  uiid  tlu;  Fish  Cf)inriiiBHioii  ; 
the  Department  of  Jildii cation  ;  the  National  Academy  of  Sei- 
ences,  which,  by  law,  ia  requinsd  to  liold  its  annual  seHsions 
in  this  city  ;  and  the  vohmtary  .scientific  orji;ani/ation8  known 
as  the  Piiiloso|)hi(;al,  J}ioh)gical,  and  Antliropological  Socie- 
ties, which  bring  tofjjcther  at  stated  periods  the  men  of  learning 
and  science  residing  here  either  officially  or  for  convenience 
or  comfort,  and  you  will  realize  something  of  the  scope  and 
importance  of  the  scientific  and  educational  work  now  carried 
on  in  this  city,  as  well  as  the  prominent  position  already 
achieved  by  science  and  the  justification  for  our  faith  in  the 
greatness  of  its  future. 

And  now,  having  briefly  suggested  our  present  and  j)rospec- 
tive  claims  to  a  prominent  place  as  a  scientific  centre,  will  you 
not  join  with  me  in  the  hope  that  this,  the  cosmopolitan  city 
of  the  nation,  the  heart  of  its  political  life,  may  also  speedily 
become  its  scientific  and  educational  Mecca  as  well  ? 

There  is  still  another  relation  which  the  government  holds 
to  its  capital,  the  wisdom  of  which  one  cannot  fully  appreciate 
without  a  residence  long  enough  to  observe  its  practical  bear- 
ing. By  a  provision  of  the  Constitution  the  territorial  area 
is  held  under  the  exclusive  jurisdictiou  of  Congress.  The 
government  holds  iu  fee  simple  the  title  to  all  the  public  high- 
ways, the  public  buildings,  and  the  numerous  parks  ;  makes 
all  laws  ;  appoints  all  officers  ;  levies,  collects,  and  disburses  all 
taxes  ;  and  contributes  an  equal  amount  to  the  support  of  the 
municipality.  To  her  the  citizens  are  indebted  for  these  beau- 
tiful streets,  the  avenues  of  shade-trees,  the  flowing  fountains, 
and  tlie  decorated  parks  which  adorn  the  landscape  at  every 
turn  with  foliage,  flowers,  and  sward,  and  contribute  so  much 
to  the  healthf  ulness  of  the  citv. 

This  is  the  capital  of  a  great,  growing,  and  prosperous 
nation,  beautiful  in  design  and  susceptible  of  greater  and 
more  magnificent  embellishment.  Every  citizen  of  the  country 
should  share  iu  the  wish  for  its  substantial  improvement 
and  adornment,  that  it  may  become  commensurate  with  its 


268  ESSAYS  AND  ADDRESSES. 

importance  and  capabilities.  Tlie  time  is  not  very  remote 
when  the  fostering  care  of  a  generous  government  and  the 
energy  of  its  resident  population  will  make  it  the  most  desira- 
ble city  for  residence  in  this  great  and  populous  country ; 
when  its  suburban  elevations  will  be  covered  with  winter 
residences  and  summer  villas  rivalling  in  beauty  and  grandeur 
the  taste  and  display  along  the  cliff  at  Newport. 

I  need  hardly  tell  you  that  Washington  is  a  healthy  city; 
but  I  will  send  a  message  through  each  one  of  you  to  the 
people  at  your  homes,  that  you  may  tell  them  how  much  their 
government  is  doing  to  improve  the  healthf  ulness  of  this  city. 
In  times  past  we  have  read  the  graphic  descriptions  of  the 
dreadful  malaria  that  was  so  dense  it  could  be  sliced  into 
blocks,  followed  people  in  fierce  pursuit  at  every  turn  during 
the  day,  howled  under  the  eaves  at  night,  stole  through  the 
stomach,  and  sneaked  under  the  nether  garments.  But,  thanks 
to  the  government,  the  river-marshes  are  being  reclaimed,  and, 
in  the  near  future,  the  river-front  of  our  city  will  be  covered 
by  a  magnificent  park,  washed  along  its  entire  shore  by  the 
swift  current  of  a  river  of  drinking-water.  You  may  tell 
them  too,  if  you  please,  that  the  malaria  of  the  correspondent 
and  casual  visitor  covers  some  one  or  more  of  the  great  variety 
of  excesses  which  prudent  people  should  not  commit.  Take 
home  with  you  this  message,  from  one  who  has  lived  forty 
years  in  sight  of  and  breathed  the  air  coming  with  every 
southern  wind  over  the  Potomac  flats,  and  has  never  yet  had 
the  fever  and  ague. 


ESSAYS  AND  A  DDIilCSSES.  2(')'.) 


amp:rican  gynecological  society. 


ADDRESS  OP  WELCOME   TO   THE  AMERICAN  QYNEC()U)(iICAJj 

SOCIETY,    DEl-lVKUED    AT    WASHINGTON, 

SEPTEM15ER    18,    1888. 

Mr.  President  and  Fellows  :  The  American  Gyneco- 
logical Society  is  always  welcome  in  tiiis  the  nation's  capital 
city.  We  are,  it  is  true,  indebted  to  the  courtesy  of  the 
Boston  Fellows,  who  voluntarily  relinquished  their  claim, 
even  after  their  city  had  been  selected  as  the  place  for  the 
present  meeting.  Yet  the  Resident  Fellows,  the  profession, 
and  citizens  of  this  city,  and  the  members  of  other  special 
medical  societies  which  have  assembled  here  to-day,  offer  to 
you  the  welcome  which  is  due  to  an  organization  of  physi- 
cians which  numbers  among  its  membership  so  many  men 
whose  scientific  work  is  known  throughout  those  parts  of  the 
civilized  world  where  medical  science  is  cultivated  and  appre- 
ciated. 

As  the  Chairman  of  the  Committee  of  Arrangements  of 
the  Congress  of  American  Physicians  and  Surgeons,  I  take 
more  than  ordinary  pleasure  in  bidding  you  welcome  to-day. 
You  have  come  to  meet  others  equally  eminent  in  the  various 
special  departments  of  medicine,  who  are  seeking  to  perfect 
and  solidify  an  organization  which  will  unite  men  of  pre- 
eminent abilities  in  a  common  effort  to  elevate  medical  science 
in  this  country  to  that  high  standard  which  shall  be  commen- 
surate with  the  progress  of  research  into  the  cause,  nature, 
and  treatment  of  disease.  You  have  come  also  to  meet  and 
have  brought  with  you  men  from  abroad  whose  honorable 
bearina;  and  good  work  have  added  lustre  and  renown  to  the 


270  ESSAYS  AND  ADDRESSES. 

profession.  Since  you  have  come  to  aid  others  in  their  efforts 
to  promote  the  welfare  of  a  common  humanity,  I  need  not, 
therefore,  offer  any  apology  for  the  gratification  it  gives  me 
to  welcome  you  to-day. 

Without  your  presence  the  assemblage  of  distinguished  men 
here  to-day  would  have  seemed  incomplete.  A  society  that 
has  given  to  the  world  thirteen  volumes  of  transactions  re- 
plete with  valuable  information,  and  has  won  in  this  country 
certainly  the  leadership  in  obstetrics  and  gynecology,  could 
not  relinquish  its  position  as  the  equal  of  any  other  special 
medical  society  by  its  absence  from  this  city  ou  this  occasion. 
It  must  necessarily  be  a  constituent  part  of  any  great  assem- 
blage of  eminent  physicians  and  surgeons.  Arid  the  welcome 
I  give  you  is  enhanced  by  the  fact  that  your  presence  assures 
the  success  of  an  organization  which  will  establish  a  new  era 
in  the  history  of  American  medicine ;  an  era  that  means  a 
pull  altogether,  and  all  along  the  line,  to  promote  the  progress 
of  scientific  medicine.  While  I  cannot  offer  you  the  excel- 
lence in  social  entertainment  with  which  the  Boston  Fellows 
would  have  greeted  you,  I  will  promise  you  a  more  varied 
intellectual  feast. 


THE  WRONG  OF  CRANIOTOMY  UPON  THE 
LIVING  FCETUS. 

SIXTH    ANNUAL.   ADDRESS    OP   THE    PRESIDENT,    DELIVERED 
BEFORE    THE    WASHINGTON   OBSTETRICAL    AND    GYNE- 
COLOGICAL  SOCIETY,  OCTOBER    19,    1888. 

In  my  first  annual  address,  delivered  before  this  Society 
five  years  ago,  I  predicted  that  the  discussion  of  the  relative 
propriety  of  the  operation  of  craniotomy  upon  the  living 
fcetus  and  the  Csesarean  section,   then   in    progress,   would 


/';.s',s'/i  )',s'  AND  Ai)i)iu<:ssi':s.  271 

result  in  u  modilicatiuu  ol'  the  views  held  hy  u  inajfjrity  of 
obstetricians,  and  that  the  time  would  come  when  the  C'jnsa- 
rean  section  and  other  conservative  ])roceflnreH  which  ofTcred 
the  chance  of  saving  two  lives  would  supplant  the  killing  of 
the  fcTctijs  that  the  chances  of  the  mother's  recovery  might  be 
improved.  I  did  not  then  anticipate  the  rapid  progress  of 
the  revolution  which  I  felt  assured  had  begun,  nor  that,  at 
this  early  date,  science  would  liave  so  nearly  accomplished 
tliat  result.  After  five  years'  submission,  without  remon- 
strance, to  adverse  criticism,  you  will  pardon  my  exjires- 
siou  of  the  pleasure  it  gives  me  to  recur  to  this  subject, 
not,  as  then,  a  postulant,  canvassing  the  issue  of  justifiability, 
but  now,  as  a  predicant,  asserting  the  wrong  of  craniotomy 
upon  the  living  foetus.  This  proposition  advances  a  step  be- 
yond the  inquiry  discussed  in  ray  first  address,  and  involves 
the  question  of  moral  responsibility  as  v/ell  as  the  issue  of 
scientific  investigation  and  result.  It  may  be  that  my  views 
are  extreme ;  but  if  advances  in  the  science  and  practice  of 
obstetrics  are  limited  to  the  domain  of  long-established  usage 
and  generally  accepted  principles,  progress  must  cease.  If  the 
early  followers  of  McDowell  had  laid  aside  the  scalpel  at  the 
bidding  of  their  assailants,  abdominal  surgery  would  not  now 
be  crowned  with  the  brilliant  successes  of  the  great  ovarioto- 
raists  whose  achievements  are  known  in  every  laud  where 
medical  and  surgical  science  is  cultivated.  Nay,  more  ;  if  they 
had  been  discouraged  by  the  unfavorable  results  in  the  begin- 
ning, ovariotomy  would  long  since  have  been  consigned  to 
the  catalogue  of  unjustifiable  operations,  and  the  unnecessary 
sacrifice  of  woman's  life  would  have  continued  as  a  memorial 
of  the  inadequacy  of  scientific  medicine. 

To  state  the  issue  plainly,  the  averment  must  be  made  that 
no  conscientious  physician  would  deliberately  and  wilfully 
kill  a  fcetus  if  he  believed  that  the  act  was  a  violation  of  the 
commandment,  '^  Thou  shalt  not  kill."  It  has  been  well 
said  by  Barnes,^  the  highest  authority  on  operative  obstetrics 

1  British  Medical  Journal,  October  2,  1SS6,  p.  624. 


272  ESSAYS  AND  ADDRESSES. 

and  the  ablest  and  most  conservative  defender  of  craniotomy, 
"  It  is  not  simply  a  question  for  medicine  to  decide.  Religion 
and  the  civil  law  claim  a  voice — a  preponderating  voice.  In 
the  whole  range  of  the  practice  of  medicine  there  arises  no 
situation  of  equal  responsibility,  of  equal  solemnity."  Main- 
taining^ the  affirmative  of  the  proposition  that  the  profession 
can  and  must  escape  from  such  a  solemn  responsibility,  I 
hold  that  we  must  strike  directly  at  the  root  of  the  evil, 
which  declares  that  ''  it  is  the  mother's  right  to  save  her  life 
even  at  the  sacrifice  of  her  child,"  and  abolish  a  plan  of 
treatment  which  the  experience  of  past  ages  has  handed 
down  to  us  and  vindicated  by  the  assertion  of  the  right  to 
take  one  life  rather  than  leave  two  to  die.  We  must,  in  the 
interest  of  a  broader  humanity  and  a  far  wider  field  of  use- 
fulness, accept  the  progress  of  science  and  offer  chances  to 
two  lives,  rather  than  take  the  one  which  cannot  assure  the 
safety  of  the  other.  In  the  remote  past,  when  obstetric  opera- 
tions were  at  best  performed  with  rude  appliances  and  in  a 
bungling  and  unscientific  manner  by  operators  lacking  in 
knowledge  and  experience,  such  interpretation  of  the  moral 
law  must  have  been  cherished  as  a  blessing  to  humanity ;  but 
'^  under  the  new  regime  the  interest  of  the  living  child^  will 
constitute  a  more  important  factor,"  and  the  public  will 
demand  the  highest  skill  attainable  in  obstetrics.  Directly 
opposed  to  such  progress  is  the  assertion  of  the  right  to  take 
life  at  will,  supported  by  the  equally  untenable  assertions  of 
easy  accomplishment^  and  small  mortality  of  mothers.  With 
the  issue  thus  made  up,  I  proceed. 


1  The  improved  operation  has  given  results  in  Germany  so  satisfactory  that  possibly 
the  day  is  at  hand  when  craniotomy  upon  the  living  fcetus  will  be  very  rarely  per- 
formed, if  done  at  all. — Parvin,  Medical  News,  vol.  lii.  p.  652. 

-  Prof.  Miller:  Transactions  Ninth  International  Congress,  vol.  ii.  p.  304. 

3  "To  reduce  the  bulk  of  the  child,  or  to  extract  its  mutilated  remains  through  a 
pelvis  of  two  and  one-half  or  less  conjugate,  is  an  operation  of  extreme  difficulty,  one 
occupying  a  very  considerable  period  of  time,  and  needing  for  its  successful  accom- 
jjlishment,  as  far  as  the  mother  is  concerned,  a  very  great  experience  and  an  amount 
of  manual  dexterity  hardly  to  be  acquired  outside  of  a  large  city  ;  while,  on  the  other 
hand,  the  Csesarean  section  is  an  easy  operation,  capable  of  successful  performance 


J'JSSAVS  AND  ADDIH'JSSKS.  21?, 

The  ri<z;lit  or  wroiij^  of  craiiiotoiiiy  upon  the  llvin;^  ActuH 
forces  itsciU'  into  the  fore<^rouii(l  of  tliis  (liseu.s.sion  becauHe  this 
unsettled-  issue  is  the  obstacle  thwarting  the  a«lvanc;e  in  the 
methods  of  conservation  of  human  life.  Until  the  unjnstifi- 
ability  of  the  allo2;(Kl  ridit  to  kill  a  f(jRtns  at  will  to  enhance 
the  chances  of  life  to  the  mother  is  fully  demonstrated,  and 
the  wron<5  of  it  laid  bare  in  the  fulness  of  its  enormity,  the 
law  of  justification  will  be  invoked  to  cover  tlic  j)lfia  of 
expediency. 

I  will  not  characterize  craniotomy  upon  the  living  foetus 
as  a  crime  in  the  ordinary  acceptation  of  the  word — that  is,  a 
deliberate,  wilful,  and  malicious  malefaction.  Nor  would  I 
invoke  the  enactment  of  penal  laws  upon  the  subject.^  Nor 
do  I  assume  censorship  of  professional  conscience.  Neither 
do  I  maintain  that  one  who  may  differ  with  me  is  necessarily- 
wrong.  I  concede  to  every  qualified  obstetrician  the  right  of 
private  judgment,  and  recognize  the  moral  responsibility  of 
every  one  for  his  own  acts.  Nevertheless,  I  wonld  seek  to 
cultivate  and  disseminate  a  higher  and  broader  conception  of 
moral  duty  than  that  which  reposes  in  conscientious  security 
upon  the  assumed  right  to  kill  an  unborn  child  "  in  the  in- 
terest of  the  life  of  another,  responsible  for  its  existence," 
when  there  is  sufficient  evidence  to  justify  other  procedures 
''  equally  in  the  interest  of  both  mother  and  child. "^ 

by  any  surgeon  of  ordinary  skill."— Kinkead,  British  Medical  Journul,  October  2, 
1886.  p.  626. 

"  The  argument  that  such  operations  as  that  of  Porro  would  fall  largely,  of  neces- 
sity, into  the  hands  of  men  inexperienced  in  abdominal  surgery  was  not  of  much 
value ;  for  exactly  the  same  thing  was  true  of  bad  cases  of  craniotomy,  and  he 
felt  certain,  of  the  two  classes,  under  similar  circumstances,  the  resulting  advantages 
would  be  largely  on  the  side  of  amputation  of  the  uterus." — Tait,  British  Medical 
Journal,  October  2,  18S6,  p.  627. 

1  "I  would  welcome  the  euactment  of  laws  against  this  practice  in  all  civilized 
countries."— Wathen,  Ti-ansactions  Ninth  Interimtional  Medical  Congress,  voL  ii. 
p.  372. 

2  Mr.  Tait  feels  certain  that  "the  decision  of  the  profession  will  be  before  long  to 
give  up  the  performance  of  those  operations  destructive  to  the  child  in  favor  of  an 
operation  which  saves  it,  and  subjects  the  mother  to  little  more  risk."— British  Medi- 
cal Journal,  October  2,  1SS6,  p.  624. 

The  operation  of  amputation  of  the  pregnant  uterus.  I  venture  to  predict,  will 
revolutionize  the  obstetric  art,  and  in  two  years  we  shall  hear  no  more  of  craniotomy 

18 


274  ESS  A  YS  AND  ADDBESSES. 

While  I  forbear  to  characterize  the  sacrificial  operation  as 
a  crime,  I  will  antagonize  the  charge  of  sentimentality  so  fre- 
quently and  flippantly  made  against  those  who  would  offer 
chances  to  two  lives  rather  than  take  the  one  which  cannot 
assure  the  safety  of  the  other,  with  the  counter-charge  that 
those  who  claim  the  right  to  take  life  as  the  mere  choice  of 
obstetric  or  surgical  procedure  assert  a  prerogative  as  arbi- 
trary in  its  conception  as  it  is  cruel  in  its  execution.  An 
operation  which,  in  a  spirit  of  evasive  defence,  has  been 
admitted  by  its  advocates  and  defenders  to  be  abominable, 
repulsive,  horrible,  detestable,  and  execrable,  must  partake 
more  of  the  nature  of  a  sacrilege  than  a  sacrifice ;  and  that 
sentimentality  which,  by  its  abolition,  would  relieve  obstetric 
science  from  the  necessity  of  such  dreadful  admissions,  needs 
no  other  defence  than  the  courage  to  assert  itself. 

The  killing  of  the  unborn  foetus  must  be  intentional  and 
deliberate  and  executed  intelligently,  or  otherwise  it  is  mani- 
festly a  crime.  In  the  present  state  of  medical  and  obstet- 
rical science  ignorance,  haste,  convenience,  and  want  of  prep- 
aration cannot  be  offered  as  pleas  in  abatement  of  the  wrong. 
Incompetency  to  do  that  which  others  can  do  cannot  justify 
a  foeticide.  Intentional  and  deliberate  killing  must  find  its 
justification  in  some  law,  either  civil,  scientific,  or  moral. 
Self-preservation  is  the  first  law  of  nature ;  but  neither  the 
civil  nor  the  moral  law  will  accept  the  arbitrament  of  any 
one  man's  judgment  on  so  momentous  a  question.  Criminal 
law  assumes  to  ascertain  and  measure  the  degree  of  guilt  by 
defined  methods  of  judicial  procedure.  Established  usage  may 
constitute  an  adequate  plea  in  justification  or  abatement  of 
many  wrongs  committed  in  the  ordinary  concerns  of  human 
life,  but  it  offers  no  escape  from  the  responsibilities  of  crim- 
inal acts,  even  though  it  may  mitigate  the  punishment  of 


or  eviscerations,  for  this  new  method  will  save  more  lives  than  these  proceedings  do, 
and  it  is  far  easier  of  performance.  It  is  the  easiest  operation  in  abdominal  surgery, 
and  every  country  practitioner  ought  to  be  able  and  always  prepared  to  do  it.— 
LawsonTait,  Medical  Record,  November  10,  1888,  p.  557. 


ESSAYS  AND  ADDRESSES.  27o 

penal  offeiuieH.  Custom  and  usage  may  cxeiise,  and  rivil 
and  (Timinal  law  mayaf'f|iilt  (lie  aecused  ;  hut  ncMflifr  of  tlu-.'-e 
avenues  affords  escape  from  tin;  moral  responsibility  of  inten- 
tional and  deliberate  killing. 

T  do  not  introduce  the  references  to  the  civil  and  criminal 
law  to  degrade  tlie  alleged  wrong  of  craniotomy  upon  the 
living  foetus  to  the  level  of  an  ignominious  offence,  but  to 
exclude  tiie  argument  of  justification  based  upon  the  absence 
of  common  law  or  statutory  prohil)ition,  and  to  reassert  the 
principle  of  moral  responsibility  above  and  beyond  any  legis- 
lative definition. 

It  is  established  by  the  consensus  of  professional  opinion 
that  the  operation  has  been  frequently  performed  in  cases 
where  delivery  could  have  been  safely  accomplished  by  the 
forceps,  turning,  or  even  by  the  unaided  powers  of  nature. 
A  dogma  that  accepts  and  justifies  a  procedure  conducive  to 
results  so  repulsive  to  Christian  civilization  and  humanity, 
and  so  obstructive  to  the  progress  of  science,  should  seek 
defence  upon  a  higher  plane  of  professional  duty  than  'the 
mere  assertion,  without  proof,  of  the  right  to  take  the  life 
of  one  innocent  human  being  to  increase  the  chances  of  the 
recovery  of  another. 

The  wrong  of  craniotomy  on  the  living  foetus  is  a  more 
complex  offence  than  a  wrong  act  inflicted  upon  one's  self. 
If  the  moral  dereliction  could  be  limited  to  the  responsibility 
of  the  operator,  it  might  be  submitted  to  the  arbitrament  of 
his  own  conscience;  but  the  greater  offence  is  committed 
against  the  purest  type  of  an  innocent  and  defenceless  human 
being — an  unborn  child  which  has  reached  that  stage  of  its 
development  which  tits  it  for  an  independent  life — at  the  will 
and  on  the  judgment  of  one  whose  office  and  duty  it  is  to  pre- 
serve that  life. 

Conception  is  the  product  of  cohabitation.  With  cohabita- 
tion and  insemination  the  function  and  office  of  the  male  in 
the  production  of  a  new  being  terminate.  Not  so,  however, 
with  the  female.     The  laws  of  procreation  entail  upon  the 


276  ESSAYS  AND  ADDRESSES. 

woman  the  obligatious  and  responsibilities  of  maternity,  which 
are  equally  as  high  in  the  scale  of  natural  attributes  and  more 
imperative  in  all  the  requirements  for  their  complete  fulfil- 
ment. It  must  then  follow  that  the  child  is  entitled  to  life, 
even  at  increased  risk  to^  the  mother.  The  doctrine  of  re- 
sponsibility of  the  operator  for  his  own  act  cannot  condone 
the  composite  offence.  He  may  but  play  the  part  of  accom- 
plice in  the  final  act  of  the  drama  of  the  wrong,  but  the 
bloody  hand  may  be  none  the  less  guilty,  for  complicity  and 
connivance  are,  at  least,  accessory  wrongs.  Women  in 
travail  are  not  infrequently  terrorized  at  the  mere  sugges- 
tion of  the  necessity  of  manual  or  instrumental  interference, 
but  accept  with  alacrity  any  alternative  which  promises  to 
terminate  their  agony.  It  quite  as  often  happens  that  the 
grief  of  a  disappointed  and  blighted  maternity  can  only  be 
solaced  by  the  coming  of  another.  If  the  improved  Cesarean 
section  is  not  necessarily  fatal  to  either  mother  or  child,  and 
offers  fair  promise  of  life  to  both,  and  craniotomy  falls  far 
short  of  such  a  promise,  while  it  loads  the  mother's  heart 
with  sorrow  and  taints  her  life  with  guilt,  surely  the  accom- 
plice of  such  a  deed  of  evil  cannot  ransom  the  wrong  with 
the  dogma  of  absolution  by  virtue  of  his  doctorate  in  medi- 
cine. 

The  mother's  love  of  offspring  is  the  most  acute  and  in- 
tense passion  of  human  life  and  animal  instinct.  No  obste- 
trician need  be  reminded  of  the  anxious  inquiries  concerning 
the  safety  of  her  child  so  often  made  during  the  agony  of  her 
travail,  her  joy  at  the  first  cry  of  independent  life,  her  devo- 
tion to  the  infant  at  the  breast,  and  her  willing  sacrifice  of 
strength,  health,  comfort,  and  pleasure  during  the  after-life 
of  the  fruit  of  her  womb.  Are  such  qualities  mere  exhibi- 
tions of  emotion  induced  by  the  current,  passing,  and  evanes- 
cent events  of  her  life,  or  are  they  attributes  of  that  divinity 
of  soul  that  makes  her  the  helpmeet  of  man  and  the  emblem 

1  Thomas. 


KSSA  VS  AND  A  I ) I ) I ! HSS ICS.  'Ill 

of  all  tliat  is  pun;  .'iiid  j^ood  in  life;?  '^FIk'  !illril)iit('H  of  riialfr- 
uity  find  llieir  beginning  in  tlio  innate  ((nalitios  of  liuraan  lif*; ; 
manifest  their  obvious  presenee  in  the  amusementB,  pleas- 
ures, and  ])aHfinieH  of  infaney  and  (iliildliofjd  ;  grow  with 
pubcrtic  development ;  intensify  with  adolcsecnee  ;  and  attain 
fruition  with  the  birth  and  eare  of  a  living  <'hild.  From  its 
beginning  to  the  end  of  intellectual  life  maternity  is  a  cease- 
less i)assion,  enshrined  in  truth,  virtue,  sincerity,  forgiveness, 
and  self-abnegation,  and  hallowed  ''in  devotion  of  the  heart 
in  all  its  depths  and  grandeur."  The  sublimity  of  such 
natural  endowments  carries  with  it  the  force  and  conviction 
of  condemnation  of  wilful  assent  to  and  complicity  in  the 
destruction  of  a  foetus  at  maturity,  and  asserts  the  preroga- 
tive of  a  child  to  live  at  increased  risk  to  the  mother.  It 
cannot  be  that  the  complex  processes  of  conception  and  utero- 
gestation,  the  organization,  construction,  and  equipment  of  a 
new  being  for  an  independent  life,  and  the  agony  and  danger 
of  parturition  mean  nothing  more  than  the  right  of  life  by 
consent  of  mother  and  the  will  of  the  accoucheur. 

There  can  be  tio  higher  obligation  of  professional  duty  than 
the  promotion  of  the  welfare  and  the  saving  of  the  lives  of 
those  committed  to  the  care  and  judgment  of  a  Christian 
physician.  This  duty  cannot  be  wholly  discharged  short  of 
the  conscientious  and  intelligent  application  of  such  resources 
of  art  and  science  as  may  be  known  to  promise  the  best  result. 
When  two  beings  are  in  equal  danger,  the  killing  of  one  not 
necessary  to  and  not  assuring  the  safety  of  the  one  respon- 
sible for  the  existence  of  the  other  and  the  danger  of  both, 
cannot  fill  the  measure  of  such  duty  when  a  less  violent  pro- 
cedure offers  a  reasonable  prospect  of  saving  both  lives.  In 
rebuttal,  the  logic  of  fallacy  alleges  that  the  killing  of  the 
first  child  may  preserve  a  life  which  may  so  multiply  that 
the  aggregate  saving  of  infant  and  maternal  life  will  surpass 
anything  that  is  likely  to  be  obtained  by  the  Cresarean  sec- 
tion. This  sophism  takes  no  account  of  the  uncertainties  of 
events,  encounters  the  danger  to  both  mother  and  child  of 


278  ESSAYS  AND  ADDRESSES. 

premature  labor  induced  at  varying  periods  of  fcjetal  viability, 
and  suppresses  the  rule  of  successive  breeding  and  killing  at 
the  pleasure  of  the  woman  and  the  will  of  the  operator.  It 
wholly  ignores  the  fact  that  the  Cesarean  section  may,  with 
slightly  less  percentage  of  chance  to  the  mother,  save  both 
lives  and  restore  to  the  woman  incapacitated  by  pelvic  de- 
formity the  privilege  and  power  to  give  birth  to  an  indefiuite 
number  of  children,'  and  that  Porro's  modification  may  save 
both  lives  and  prev^eut  subsequent  pregnancies.  But  such 
illogical  reasoning  finds  its  complete  refutation  in  the  absence 
of  any  clinical  data  upon  which  its  allegation  could  be  based, 
and  the  numerous  instances  in  which  women  have  preferred 
Csesarean  section  rather  than  permit  a  repetition  of  crani- 
otomy. There  is  no  case  known  to  me  where  a  woman  upon 
whom  the  section  has  been  successfully  performed  has  refused 
to  submit  to  its  repetition  in  a  subsequent  pregnancy. 

The  sentence  of  condemnation  has  long  since  been  pro- 
nounced against  criminal  abortion.  No  one  of  you  would 
produce  an  abortion  to  conceal  an  illegitimate  pregnancy,  nor 
for  any  reason,  except  such  as  would,  in  your  conscientious 
judgment,  make  the  death  of  the  mother,  and  consequently 
of  the  foetus,  otherwise  inevitable.  Neither  would  you  in- 
duce premature  labor  at  any  stage  of  foetal  viability  except 
to  save  the  mother  and  to  offer  a  reasonable — in  many  cases 
an  increased — chance  of  life  to  the  child.  The  death  of  a 
pregnant  woman  necessarily  causes  the  death  of  an  undeliv- 
ered child.  According  to  the  latest  review  of  the  subject,^ 
maternal  mortality  is  8.2  per  cent.,  two-tenths  less  than  that 
of  craniotomy.^  While  the  maternal  mortality  is  but  a  frac- 
tion in  favor  of  induced  premature  labor,  the  saving  of  life 
in  the  aggregate  has  so  magnified  the  importance  and  advan- 
tages of  the  procedure  that  it  has  become  an  accepted  and 

1  See  the  collection  of  cases  of  multiple  Csesarean  section  by  Lungren,  American 
Journal  of  Obstetrics,  vol.  xiv.  p.  78. 

2  Wyder :  Ann.  de  Gyn.  et  d'Obst^t.,  January,  1888 ;  quoted  from  New  York  Medi- 
cal Journal,  vol.  xlvii.  p.  641. 

3  Ibid. 


ESS  A  YS  AND  A  I)  J)  It  KSSKS.  2  7  0 

established  altcrnntive  of  craniolotiiy,  especially  applieahN-  in 
conditions  of  pelvic  contractions  in  which  the  craiilotoinist« 
insist  the  latter  is  the  elective  operation.  The  mortality  of 
weak  and  immature  children  is  very  lar[:;e,  hut  the  invention 
and  application  of  the  incubator  of  Tarnierhave  reduced  it  U) 
36.6  per  cent.;  so  that  the  ratio  of  lives  saved  is  as  155.2 
in  200  to  91.6  in  200  by  craniotomy.  It  is  then  evident 
that  the  induction  of  premature  labor  has  acquired  priority 
in  the  chronological  order  of  alternative  procedures  because 
of  the  aggregate  saving  of  life;  and  its  universal  acceptance 
gives  emphatic  expression  to  the  supreme  and  dominating 
passion  of  maternity  and  to  the  widespread  abhorrence  for 
the  dogma  and  practice  of  craniotomists.  From  this  there  is 
no  escape,  for  there  is  no  one  capable  of  conscientious  reflec- 
tion who  would  offer  the  condouement  of  two-tenths  of  one  per 
cent,  less  of  maternal  mortality  in  favor  of  induced  prema- 
ture labor  for  the  deliberate  killing  of  one  hundred  unborn 
children.  But  fairness  even  to  such  a  reprehensible  practice 
demands  tlie  statement  that  the  artificial  provocation  of  labor 
at  a  selected  time  is  only  applicable  to  such  cases  in  ''  which 
previous  clinical  knowledge,  confirmed  by  exploration  made 
before  and  during  early  gestation,  has  demonstrated  the  inca- 
pacity of  the  woman  to  bear  a  living  child  at  term."  Never- 
theless, the  obligation  to  possess  such  knowledge  at  the  ear- 
liest practicable  period  of  pregnancy  is  not  less  imperative 
than  it  is  to  conduct  her  safely  through  the  perils  of  her 
travail. 

''The  brutal  epoch  of  craniotomy"  has  certainly  passed. 
''  The  legitimate  aspiration  and  tendency  of  science  (Barnes') 
are  to  eliminate  craniotomy  on  the  living  and  viable  child  from 
obstetric  practice ; "  and  it  may  be  that  the  realization  of  the 
dream  of  Tyler  Smith-  will  be  the  crowning  achievement  of 
the  surgery  of  the  nineteenth  century. 

Craniotomy  is  the  oldest  capital  and  most  deadly  obstetric 

1  British  Medical  Journal.  October  2, 1866.  p  623. 
-  Obstetric  Trausactions,  London,  vol.  i.  p.  ~\. 


280  ESSAYS  AND  ADDRESSES. 

operation.  It  was  devised  in  the  infancy  of  the  art  to  rescue 
women  from  the  difficulties  then  regarded  as  otherwise  in- 
superable. The  history  of  obstetric  progress  since  that  remote 
period  points  with  significance  to  the  fact  that  every  great  dis- 
covery (Tyler  Smith)  in  this  branch  of  medicine  is  in  direct 
''opposition  to  it  aud  has  invariably  tended  to  diminish  the 
frequency  of  its  performance  where  the  child  was  living." 
Even  the  Caesarean  and  Sigaultian  sections,  which  in  the 
beginning  were  but  little  less  fatal  to  the  mother  than  per- 
foration is  to  the  child,  were  attempts  to  escape  the  "  mas- 
sacre of  the  innocents."  Then  followed  in  chronological 
order  the  discovery  of  turning,  the  forceps,  and  the  induction 
of  premature  labor;  and,  subsequently,  the  application  of 
oxytocics  and  auscultation  to  obstetrics  ;  the  discovery  of  the 
physiology  and  mechanism  of  labor  ;  numerous  minor  im- 
provements ;  anaesthesia,  antisepsis,  laparo-elytrotomy  by 
Thomas,  axis-traction  forceps,  Porro's  operation  ;  and, 
finally,  the  improved  Caesarean  section  by  Saenger.  As 
century  after  century  has  slowly  rolled  into  the  oblivion  of 
the  past,  so  has  the  opprobrium  of  obstetrics  receded  before 
the  gradual  evolution  of  mere  handicraft  into  a  science  which 
has  saved  empires  of  lives  ;  which  now  commands  the  ad- 
miration of  the  civilized  world  and  daily  receives  the  bless- 
ings of  millions  of  women.  The  present  has  surpassed  any 
previous  century  in  scientific  discovery  and  advancement. 
In  no  department  of  science  has  this  advance  been  more 
marked  than  in  medicine  ;  in  no  branch  of  medicine  more 
than  in  obstetrics,  and  in  none  of  the  subdivisions  of  obstet- 
rics more  than  in  the  saving  of  maternal  and  infantile  life. 
Nevertheless,  this  barbarous  relic  of  a  pre-anatomic  period, 
with  its  annual  sacrifice  of  six  thousand  eight  hundred  and 
eighty  lives  in  this  country  alone,^  remains  a  blot  on  the 
marvellous  progress  of  the  nineteenth  century  and  a  reproach 

1  This  result  i?  obtained  by  a  calculation  made  upon  the  basis  of  sixty  millions  of 
people,  with  a  ratio  of  thirty-six  births  (U.  S.  census,  1880)  to  every  one  thousand  of 
population,  and  the  proportion  of  one  craniotomy  (Tyler  Smith)  in  every  three  hun- 
dred and  forty  labors,  the  maternal  mortality  after  craniotomy  being  8.4  per  cent. 


ESSAYS  AND  A  DDIlESSKS.  281 

to  our  profession,  so  proi^Tcs.sivr  in  all  oIImt  directions.  The 
frG((ii(>ncy  of  the  opciration  is  ho  dcpcMdmit  npon  variahility 
of  jiidjjjment  that  this  estimate  may  he  more  or  less,  aecordin;^ 
to  the  number,  will,  and  judgment  of  the  operators — the  sen- 
tence and  its  execution  being  alike  asserted  prerogatives. 
Collins  performed  the  operation  ontie  in  141  cases  of  labor, 
Clark  once  in  248,  and  Ramsbotham  onee  in  805  ;  whereas 
Siebold  performed  it  only  onee  in  2095,  Baudelocque  only 
once  in  2898  cases,  and  More  Madden,  in  a  long  and  large 
experience  in  hospital  and  private  practice,  has  never  once 
recognized  its  necessity  or  countenanced  its  performance.' 
The  extraordinary  frequency  of  the  operation  in  the  practice 
of  competent  obstetricians  is  explicable  only  upon  tlie  theory 
of  an  automatic  belief  in  its  justifiability,  which  invokes  the 
more  "  sweeping  doctrine  of  necessary  blamelessness^  for  erro- 
neous conclusions,"  or  the  favorite  and  broader  doctrine  of 
Ingersoll,  ^'  the  immunity  of  all  error  in  belief  from  moral 
responsibility." 

The  discovery  of  McDowell  encountered  bitter  prejudice 
and  reproach,  based  upon  the  alleged  unjustifiable  sacrifice  of 
the  lives  of  women  who  were  afflicted  with  a  disease  other- 
wise incurable.^  It  is  true  that  some  lives  are  shortened  by 
a  period  varying  from  a  day  or  a  week  to  a  year  or  two ;  but 
even  in  the  beginning  such  mortality  was  less  than  50  per 
cent.,  and  since  1809  ovariotomy  has  rescued  from  protracted 
suffering  and  premature  death  fully  75  per  cent,  of  the  cases, 
and  has  added  thousands  of  years  to  the  lives  of  women.  In 
each  of  such  cases  but  one  life  was  at  stake.  The  Cresarean 
section,  or  some  of  its  modifications,  is  performed  in  the  in- 
terest of  two  lives,  upon  women  who  cannot  give  birth  to 
their  offspring  per  vias  naturales.  The  opposition  in  this 
case  is  not  less  clamorous  and  unreasonable  than  in  the  other, 
notwithstanding  the  first  fifty  Saenger  operations  in  Europe 

1  British  Medical  Journal,  October  2,  1,^S7,  p.  627.  -  Gladstone. 

5  It  is  probable  that  occasional  instauces  of  cure  resulted  from  the  haphazard 
methods  which  have  been  long  since  abandoned. 


282  ESSAYS  AND  ADDRESSES. 

saved  80  per  ceut.  of  mothers  and  96  per  cent,  of  children, 
or  88  per  cent,  of  all  the  lives  imperilled,  while  the  best  pos- 
sible result  in  craniotomy — never,  however,  attained — would 
give  but  50  per  cent.  This  contrast  exhibits  the  complex 
and  contradictory  methods  which  good  and  competent  men, 
who  have  become  set  in  their  views,  will  employ  to  thwart 
and  obstruct  the  advance  of  science.  In  the  former  in- 
stance it  was  the  possible  shortening  of  the  life  of  a  woman 
fatally  sick  that  aroused  the  fierce  vituperation  and  denun- 
ciation; now  it  is  the  saving  of  96  per  cent,  of  children  at  a 
slightly  increased  risk  to  the  life  of  the  mothers  that  fires  the 
heart  of  the  philanthropist  who  claims  the  natural  right  to 
destroy  one-half  of  the  lives  that  the  chances  of  saving  the 
lives  of  the  other  half  may  be  improved.  The  iron-clad  con- 
science which  sought  to  drive  the  early  followers  of  McDowell 
into  ignominious  retirement  lives  only  in  the  history  of  its 
futile  efforts  to  obstruct  progress,  and  ovariotomy  has  risen 
to  the  dignity  of  universal  acceptation.  The  conscience 
which  is  to-day  seeking  to  condone  the  wrong  of  craniotomy 
with  the  good  that  evil  may  bring  will  read  a  like  history 
in  the  near  future  when  the  world  will  know  the  possibilities 
of  science,  and  the  child  will  be  saved  without  enhancing 
the  danger  of  the  mother.  As  Tait^  has  accomplished  the 
brilliant  success  of  one  hundred  and  thirty-nine  consecutive 
ovariotomies  without  a  death,  we  need  not  hesitate  to  give 
full  credit  to  his  opinion  that  one  hundred  Porro  operations 
should  not  yield  more  than  5  per  cent,  maternal  mortality.^ 

To  meet  the  charge  of  casuistry  the  logic  of  words  must 
be  reinforced  by  the  demonstration  of  facts.  It  is  admitted 
that  alternative  procedures  give  better  results  to  the  mother, 
with  high  probability  of  saving  the  child,  than  craniotomy 
when : 

1  British  Medical  Journal,  May  15,  1886,  p.  921. 

-  "If  I  had  one  hundred  Porro  operations  to  do,  before  craniotomy  or  any  other 
turbulent  proceedings  upon  the  child  had  been  attempted,  I  would  not  have  a  mor- 
tality of  more  than  four  or  five  per  cent." — British  Medical  Journal,  October  2, 1886, 
p.  624. 


/';,S',S'.I  )'.S'  AND  ADDRESSES.  283 

1.  'I'Ik!  (■()iijiiii;;il(;  (iiuiricicr  (>f  (Ik;  |)<;lviH  Ih  iwo  iiU(\  uuc- 
half  iiKilicH  or  less. 

2.  WJi(!ii  tlio  Hliort(!.st  (liamotor  moasiirnH  tlireo  and  ono- 
fourtli  iiiclicH. 

3.  In  ull  (iuscs  of  pelvic  contraction  wiicn  the  opportunity 
of  indncinijj  jjrcniatnre  labor  lias  not  ^oiio  hy, 

4.  In  oases  of  eancicrous  degeneration  of  tlic  lowe-r  uterine 
segment  and  vagina. 

5.  In  cases  of  immovable  tumors,  rujiture  of  the  uterus, 
convulsions,  hemorrhage,  and  atresia  of  the  cervix  or 
vagina. 

6.  In  cases  in  which  the  pelvic  cavity  is  obstructed  by  the 
presence  of  fibroid  or  other  tumors. 

7.  In  other  emergencies  than  deformity,  as  in  obstructed 
labor  from  ovarian  tumors. 

These  limitations  are  based  upon  the  following  facts: 

1.  That  craniotomy  cannot  in  any  case  assure  the  life  of 
the  mother. 

2.  That  it  is  necessarily  fatal  in  every  case  to  the  child. 

3.  That  in  many  cases  one  operation  demands  repetition  on 
the  same  woman. 

4.  The  maternal  mortality  varies  from  7.1  to  12.5  per 
cent.^ 

5.  The  Csesarean  section  and  other  alternatives  of  crani- 
otomy are  not  necessarily  fatal  to  either  mother  or  child. - 

To  set  forth  more  completely  the  limitation  and  iuapplica- 


1  Muude  (Annual  of  Universal  Medical  Science,  vol.  i.  p.  218)  says  that,  when  per- 
formed by  experts  under  the  most  favorable  conditions,  it  should  not  exceed  7.1  per 
cent.  Merkel  (Arch.  f.  Gyniik.,  vol.  xxl.  p.  437)  reports  from  the  Leipsic  clinic  100  cases, 
with  S  per  cent,  mortality.  Thorn  (Arch.  f.  Gynak.,  vol.  xxiv.  p.  437)  reports  80  cases 
from  the  Halle  clinic,  with  12.5  per  cent.  Wyder  (Ann.  de  Gyn.  et  d'Obst..  Jan.  1888) 
fixes  it  at  S.4  per  cent.  Of  the  ISO  cases  of  Merkel  and  Thorn,  SS  had  previously  gfiven 
birth  to  living  children. 

^  Ccesarean  section  always  held  out  promise  when  performed  under  favorable  cir- 
cumstances.—I.usk  :  British  Medical  Journal,  October  2,  1SS6,  p.  626. 

"  For  the  Ccesarean  section  two  very  powerful  arguments  may  be  advanced  :  1. 
That  the  child  is  not  sacrificed,  and  that  it  has  a  reasonable  prospect  of  being.  2. 
That  the  mother  has  a  reasonable  prospect  of  being  saved."— Barnes,  British  Medi- 
cal Journal,  October  2, 1SS6,  p.  624. 


284  ESSAYS  AND  ADDRESSES. 

bility  I  quote  from  Barnes's  summary  of  conclusions  the  fol- 
lowing four  propositions.^     (Italics  mine.) 

1.  "In  the  most  extreme  degree  of  pelvic  distortion,  when 
delivery  per  vias  naturales  can  only  be  effected  with  doubtful 
success  to  the  mother,  Porro's  operation  is  the  legitimate  alter- 
native of  craniotomy,  it  being  understood  that  the  opportunity 
of  inducing  abortion  has  gone  by." 

2.  "  In  less  advanced  degrees  of  pelvic  contraction,  but 
still  incompatible  with  the  delivery  of  a  living  child  per  vias 
naturales,  the  opportunity  of  inducing  abortion  having  gone 
by,  but  in  which  craniotomy  would  effect  delivery  with  strong 
presumption  of  safety  to  the  mother,  the  Caesarean  section 
may  be  a  proper  alternative  for  craniotomy.  This  is  the 
most  debatable  point." 

3.  "In  the  minor  degrees  of  contraction,  say  from  three 
inches  to  three  and  a  half  and  three-quarters  inches,  the  oppor- 
tunity of  inducing  labor  having  gone  by,  the  greater  safety 
to  the  mother  obtained  by  craniotomy,  and  the  prospect  of 
living  children  in  future  pregnancies  by  inducing  labor, 
make  craniotomy  the  proper  course  to  pursue." 

4.  "  When  obstruction  is  due  to  hydrocephalus  or  dropsy 
in  the  child  embryotomy  or  tapping  is  indicated." 

The  first  of  these  propositions  does  not  raise  an  issue  with 
regard  to  pregnancies  at  full  term.  Tapping  offers  the  best 
chance  to  such  a  life  as  that  described  in  the  last.  The  sec- 
ond is  declared  to  be  the  most  debatable,  and  might  be  left 
where  its  author  puts  it.  For  if  the  issue  of  safety  to  the 
mother  by  either  of  the  operations  is  thus  submitted  to  doubt, 
the  ninety-six  chances  of  saving  the  life  of  the  child  are  suffi- 
cient to  justify  and  determine  the  election  of  Csesarean  sec- 
tion, which  gives  "  strong  presumption  of  safety  to  the 
mother,"  The  third  bases  the  decisive  choice  of  craniotomy 
upon  the  hypothesis,  before  referred  to,  of  possible  "  living 
children   in   future   pregnancies    by  inducing    labor."     This 

'  The  other  conclusions  have  been  embodied  in  the  preceding  statement  of  limita- 
tion and  facts. — British  Medical  Journal,  October  2,  1886,  p.  635. 


ESSA  YS  A  Nl)  A  l)l> ItKSSKS.  285 

proposition  was  foiinnhitcd  when  Porro's  operation  was  con- 
sidered in  contrast  with  (iraniototny,  and  loses  whatever  force 
it  may  have  then  had  in  th(!  fuf^t  that  the  improvftd  Oosarean 
section  luxd  yieldcnl  a  percentage  of  livini^  children  one  and 
a  half  times  greater  than  that  of  induced  j)r(Mnatiire  lai>or, 
and,  besides,  offers  a  liigher  ])erc(!n(aj;e  of  "  pro,spef;f  f>f 
living  children  in  future  pregnancies  "  than  induced  labor. 
Dr.  Barnes  concedes  the  choice  of  induced  premature  labor 
to  craniotomy  when  tiie  child  is  living  and  viable  This 
concession  is  based  upon  the  prospect  of  saving  children  that 
would  necessarily  be  sacrificed  by  craniotomy.  It  logically 
follows,  therefore,  that  when  it  can  be  shown,  as  it  has  been, 
that  the  improved  section  saves  more  children  and  offers  better 
prospects  in  subsequent  pregnancies  than  induced  labor  does, 
the  reason  for  the  only  one  of  the  three  propositions  which 
advocates  the  election  of  craniotomy  disappears,  and  with  it 
all  justification  based  upon  that  reason.  It  is  thus  clearly 
shown  that  Barnes's  admissions,  in  view  of  the  more  recent 
advances  in  obstetrical  surgery,  absolutely  obliterate  the  field 
of  its  application  as  defined  by  him. 

The  first  proposition  qualifies  the  choice  of  Porro's  opera- 
tion in  cases  of  "  most  extreme  degree  of  pelvic  distortion," 
and  the  second  qualifies  the  debatable  issue  of  election  between 
section  and  perforation,  in  cases  of  ''  less  advanced  degrees  of 
pelvic  contraction,"  with  the  significant  words,  "  the  oppor- 
tunity of  inducing  abortion  having  gone  by."  By  inducing 
abortion  he  means  the  arbitrary  termination  of  the  pregnancy 
before  the  period  of  foetal  viability.  So  that  practically  the 
all-absorbing  question  of  deliberate  destruction  of  fcetal  life 
recurs  with  all  its  forbidden  intent,  and  this  in  the  face  of 
the  fact  that  craniotomy  in  the  first  class  of  cases  (first  propo- 
sition) is  more  destructive  of  maternal  life  than  section  was 
even  before  the  discovery  of  Porro,  or,  still  more,  the  favor- 
able improved  method  of  Saenger.  The  acceptance  and  prac- 
tice of  the  alternative  of  induced  abortion  would  constitute  a 


286  ESSAYS  AND  ADDRESSES. 

barrier  to  progress  and  relegate  obstetric  surgery  to  the  epoch 
which  its  author  has  characterized  as  brutal. 

To  bring  the  issue  more  closely  to  a  final  result  I  invite 
your  attention  to  the  analysis  and  comparative  results^  of 
Cassarean  section,  induced  premature  labor,  version,  and 
perforation  in  all  cases  of  contracted  pel  vis,  performed  in  the 
Dresden  clinic  during  the  four  years  ending  December,  1887. 

Total  maternal  mortality  from 

Induced  premature  labor     .    2.2  Perforation 2.8 

Version  and  extraction    .    .    4.8  Csesarean  section     ....    8.6 

Mortality  from  sepsis  : 

Induced  premature  labor     .    2.2  Perforation 0.0 

Version  and  extraction    .    .    0.0  Csesarean  section     ....    4.3 

Percentage  of  children  discharged  living: 

Induced  premature  labor     .  66.6  Perforation 00.0 

Version  and  extraction    .    .  59.0  Csesarean  section     ....  87.0 

Or,  to  state  the  result  in  aggregate,  as  follows  : 
Percentage  of  children  discharged  living  and  mothers  saved: 

Induced  premature  labor     ....  66.6  children.  97.8  mothers. 

Version  and  extraction        ....  59.0       "  95.2       " 

Perforation 00.0        "  97.2 

Csesarean  section 87.0       "  81.4       " 

Or  stating  the  aggregate  saving  of  life  by  each  operation, 
two  hundred  lives  being  involved  in  every  one  hundred  cases: 

Induced  premature  labor  .  164  Perforation 97.2 

Version  and  extraction  .    .  154.2  Csesarean  section   ....  178.4 

The  foregoing  j&gures  present  the  alternatives  of  Csesarean 
section  in  their  most  favorable  aspect.  The  ratio  of  maternal 
mortality  in  craniotomy  is  2.8  per  cent.,  and  yet  nearly  twice 
as  many  lives  are  saved  by  section.  Nor  should  we  overlook 
the  facts  that  one-half  of  the  maternal  mortality  of  Csesarean 
section  was  due  to  causes  beyond  the  control  of  the  operation, 
and  that  in  every  case  a  living  child  was  delivered. 

The  statistics  show  that  craniotomy  saved  5.6  per  cent, 
more   mothers   than   section,  but  the  latter  operation  offsets 

1  Review  of  contributions  of  Koru,  Lijhman,  and  Priiger.    Edited  by  Leopold. 
American  Journal  of  Obstetrics,  vol.  xxi.  p.  671. 


/';,s'>svn'-s'  and  yMnntEssEs.  287 

this  small  increased  loss  of  moflKM-s  by  j^ivin;^  us  all  the 
children  living  at  delivery  and  87  per  oent.  of  them  alive 
at  the  time  of  disc^harj:;*!  from  the  clinic.  The  issue  then  re- 
solves itself  into  the  simple  (jucstion  of  the  actual  or  relative 
value  between  the  lives  of  five  or  six  women  and  eighty- 
seven  childnMi,  If  we  base  our  conclusion  upon  the  univer- 
sally a(;(!('pted  apothegm  that  "  that  only  is  right  wliich 
produces  the  greatest  good  to  the  greatest  number,"  the  con- 
clusion is  self-evident — the  eighty-seven  must  be  saved;  and 
this  conclusion  is  reinforced  by  the  fact  that  the  five  or  six 
lives  lost  arc  those  of  women  who  cannot  give  birth  to  a 
living  child  per  tJias  naturales.  If  there  is  any  obligation' 
of  duty  or  maxim  of  the  moral  law  which  demands  the  sacri- 
fice of  eighty-seven  lives  to  improve  the  prospects  of  saving 
five  or  six  women  in  labor,  the  time  had  surely  come  for  its 
abrogation.  But  the  argument  arf  Aom/nem  replies  with  the 
specific  citation  of  the  daughter  or  wife  of  some  high  official, 
conspicuous  in  social  life,  possessing  marked  beauty  and  in- 
telligence, with  ample  wealth  which  she  devotes  to  charity 
and  benevolence,  and  holding  in  her  physique  and  constitu- 
tion the  highest  probability  of  a  long  and  useful  life,  and 
demands  to  know  if  the  life  of  such  a  woman  should  be  sub- 
mitted to  the  5.6  per  cent,  chances  of  death,  with  the  87  per 
cent,  chances  of  life  to  her  child,  rather  than  the  2.8  per 
cent.^  chances  of  death  with  the  deliberate  killing  of  her 
child.  The  picture  is  pathetic  and  moving,  but  the  answer 
is  simple  and  plain.  Both  science  and  religion  deal  with 
exceptional  cases  as  such.     The  broad  principles  of  truth, 

1  "  How  long  must  we  be  forced  by  lay  opinion  to  destroy  the  lesser  for  the  benefit 
of  the  greater  life,  when  it  can  be  conclusively  shown  that  the  Csesarean  section, 
resorted  to  in  time,  may  with  almost  absolute  certainty  result  in  the  saving  of  two 
lives'.'" — American  Journal  of  Obstetrics,  vol.  xxi.  p.  672. 

-  A  later  abstract  (American  Journal  of  Obstetrics,  vol.  xxi.  p.  779)  of  a  paper  by 
Wyder  (Archiv  f.  Gyn.,  vol.  xxxii.  i.)  states  the  maternal  mortality  of  craniotomy 
andjiuduced  premature  labor,  at  the  clinics  of  Berlin,  Halle,  and  Leipzig,  as  follows : 

Berlin,      104  cases  of  perforation 5.S  per  cent. 

Halle,         35         "  "  5.7        " 

Leipzig,      76         "  "  5.3 

Premature  labor:  306  cases  ;  mortality  .        .       .        .3.9       " 


288  ESSA  YS  AND  ADDRESSES. 

humanity,  progress,  and  development  are  not  to  be  stayed  or 
hindered  by  the  special  pleading  of  imaginary  cases  of  isolated 
hardship,  however  much  of  pathos  or  tears  they  may  suggest. 
All  lives  are  of  equal  value  in  the  eyes  of  the  true  scientist 
and  the  true  Christian,  and  the  divine  art  of  healing  can 
have  no  safer  guide  than  this  :  That  nothing  can  possibly 
justify  the  taking  of  a  human  life  unless  it  be  the  absolute 
certainty  that,  by  this  means  alone,  another  human  life  can 
be  preserved — and  this  is  the  answer  of  both  religion  and 
science. 

It  is  true  that  the  ratio  of  mortality  is  less,  but  the  uncer- 
tainty of  life  remains  the  same.  Each  woman  operated  upon 
by  either  method  takes  all  the  risks  of  the  operation.  Those 
dying  after  craniotomy  might  have  been  saved  by  section, 
and  vice  versa.  The  saving  of  the  child  is  the  only  compen- 
sation for  the  uncertainty  of  life  and  possible  error  of  elective 
procedure.  The  unflinching  discharge  of  unavoidable  duty 
is  the  only  guide  of  conduct.  The  behests  of  a  long-accepted 
dogma  should  not  thwart  the  progress  of  science  which  prom- 
ises divorcement  of  the  profession  from  lay  opinion,  which 
claims  the  destruction  '^  of  the  lesser  for  the  benefit  of  the 
greater  life." 

The  right  of  an  individual  to  select  the  alternative  of  cer- 
tain death  rather  than  submit  to  an  operation  which  may 
shorten,  but  more  probably  will  effect  a  cure  and  prolong 
life,  is  not  absolute.  In  such  case,  but  one,  and  that  the 
life  of  the  victim,  is  involved.  Such  right  cannot,  however, 
be  conceded  to  a  woman  in  labor  who  is  responsible  for  the 
existence  of  her  child  and  the  danger  of  both,  since  by  it  she 
imposes  upon  an  innocent  operator  the  act  of  killing  that  her 
prospect  of  life  may  be  slightly  improved.  The  conviction  of 
right  in  the  first  cannot  carry  with  it  the  concession  of  right 
in  the  latter  instance. 

If  a  pregnant  woman  possesses  the  natural  and  inalienable 
right  to  terminate  the  life  of  her  child  at  term,  she  cannot  be 
denied  the  right  to  terminate  it  at  any  period  of  gestation, 


KS>SAy,S  AND  ADhliHSSl'lS.  280 

and  (irliiiiiKil  iiUori.iori  would  (Jkmi  Ijccoiiic  an  acrotnpli.slitncnt 
of  tlie  l»ij;li(:sl  ,si;i;nif"i(an(!('.  'I'Ik;  early  ddHtrnctioti  of  cmhry- 
onic  lift!  would  \h\  the  simpUwt  and  snroHt  (wapo  from  the 
perils  of  iilor<)-<jj(!Htation  and  |)artMrition  ;  vvoidd  cITcflnally 
witluh'aw  from  further  scientific  pursuit  the  advances  in 
obstetrics  which  seek  the  elimination  of  craniotomy  ;  more 
certainly  extinguish  the  instincts  and  attribute  of  maternity  ; 
nullify  the  laws  of  reproduction  ;  and  reduce  woman  to  a 
level  more  degrading  than  any  to  which  the  most  barbaric  of 
primitive  people  co!isigned  her. 

The  argument  that  craniotomy  upon  the  living  and  viable 
foetus  is  the  indirect  killing  of  an  unjust  aggressor  is  a  trivial 
sophism.  The  killing  is  the  immediate  and  even  more  direct 
object  than  the  end  sought  to  be  accomplished,  for  that  is 
necessarily  attended  with  the  chance  of  safety  to  the  mother. 
It  is  a  curious  but  interesting  historical  fact  that  embryotomy 
found  its  beginning  in  the  intuitive  obstetric  practice  of  primi- 
tive peoples/  who  believed  that  all  difficulties  were  referable 
to  the  evil  disposition  of  the  child,  and  that  ''  a  child  so 
perverse  as  to  refuse  absolutely  to  appear  deserved  death,  as 
did  the  mother  who  carried  such  a  child."  Obstetrics  has 
advanced  from  the  epoch  of  intuitive  practice,  through  the 
religious  and  pre-anatomic  epochs  and  the  first  three  hundred 
and  fifty  years  of  the  scientific  period,  and  yet  there  are  very 
many  eminent  obstetricians  practically  holding  fast  to  the  doc- 
trine of  merited  death  or  justifiable  killing  of  the  foetus  for  a 
like  cause  and  a  like  method,  which  the  primitive  peoples 
could  justify  only  upon  the  theory  of  the  evil  disposition, 
perverseness,  and  unjust  aggression  of  the  unconscious  and 
passive  child.  Nevertheless,  the  savage  inhumanity  of  such 
a  doctrine  evinces  a  broader  sense  of  justice  than  is  exhibited 
by  the  craniotomists  of  to-day,  in  that  it  recognized  the  culpa- 
bility of  the  mother  to  be  equal  with  that  of  the  child. 

It  will  be  charged,  notwithstanding  the  equally  favorable 

1  Eugelmauu  ;  System  of  Obstetrics,  by  Hirst,  vol.  i.  p.  -Jo. 
19 


290  ESSAYS  AND  ADDRESSES. 

results  of  craniotomy,  that  the  maternal  mortality  of  the  alter- 
native procedures  in  the  Dresden  clinic  are  less  than  the  ratios 
of  mortality  of  the  operations  in  general.  The  utmost  fair- 
ness, therefore,  requires  that  comparative  ratios  shall  be 
obtained  from  large  numbers,  which  will  comprehend  the 
experience  of  numerous  operators.  To  this  end  the  follow- 
ing analyses  are  made  : 

In  a  private  letter,  dated  August  20,  1888,  Dr.  R.  P. 
Harris  informs  me  that  131  improved  Csesarean  operations 
had  "  been  performed  in  11  countries  by  73  operators,  with 
a  saving  of  95  women  aud  118  children." 

In  15  German  cities,  32  men  had  had  65  cases  and  saved 
56,  a  percentage  of  86| ;  only  9  deaths  in  all. 

In  5  Austrian  cities,  7  men  operated  21  times,  saving  15, 
or  71|^  per  cent. 

In  9  American  cities,  16  men  operated  20  times,  with  9 
saved,  or  45  per  cent.     The  first  5  were  all  fatal. 

Russia  saved  4  out  of  6;  Holland  saved  4  out  of  4;  France 
saved  2  out  of  4 ;  Italy  saved  2  out  of  4  ;  Switzerland  saved 

1  out  of  2  ;  India  saved  1  out  of  2  ;  England  saved  0  out  of 

2  ;  Denmark  saved  1  out  of  1  ;  71  saved  out  of  first  100 ; 
33  saved  out  of  first  50;  38  saved  out  of  second  50  ;  34  men 
saved  out  of  45  cases,  in  1887,  36  women,  or  80  per  cent. 

This  aggregate  in  its  most  unfavorable  aspect,  with  its  73 
operators  in  11  countries,  aud  including  the  educational  and 
experimental  cases  in  this  country,  shows  a  saving  of  72.52 
per  cent,  of  women  and  90.84  per  cent,  of  children.  In  other 
words,  it  shows  a  saving  of  165.36  lives  out  of  a  possible  200, 
being  65.5  more  lives  saved  than  is  possible  by  craniotomy, 
even  admitting  that  it  is  absolutely  free  from  danger  to 
women.  As  yet,  no  one  has  claimed  that  any  group  of  73 
craniotomists  has  saved  100  per  cent,  of  the  lives  of  the 
women  operated  upon,  even  though  they  sacrificed  100  per 
cent,  of  the  lives  of  the  children.  Further  comment  is  un- 
necessary. 

Later   statistics:    Caruso  (Arohiv  fur  Gyndkologie,  Band 


I'JSSAVS  AND  ADDIIKSSKS.  291 

xxxiii.  Heft  2)  lias  oollectcid  tlu;  cases  of  tlif  mcxlorn  CiCHarean 
section  up  to  October  1,  1888,  '*  er)rn|)riHiii;^  1.35  cascH;  6 
successful  cases,  in  addition,  are  known  to  Caruso,  but  the 
details  lUicessary  for  publication  were  lacking. 

''  German  operatois  have  i)erformed  74  of  these  operations  ; 
Araeri(!ans,  18;  Austrians,  16;  the  results  by  Americans  are 
inferior  to  those  of  the  Germans  and  Austrians.  The  results 
are  74.44  per  cent,  of  recoveries  among  mothers  in  all  casea 
and  91.73  per  cent,  recoveries  among  children  ;  in  three  f^ases 
in  which  the  operation  was  done  a  second  time  both  mothers 
and  children  recovered.  It  may,  therefore,  be  said  that  a 
mother  has  three  chances  out  of  four  and  lier  child  nine  out 
of  ten  for  life  with  this  operation. 

''  A  careful  estimate  of  the  results  of  craniotomy  under 
antiseptic  precautions  shows  that  93.4  per  cent,  of  the 
mothers  recover.  Selecting  similar  cases  on  which  section 
was  performed,  the  percentage  of  recoveries  in  these  cases 
was  89.4,  and  100  per  cent,  of  children.  Caruso  concludes, 
therefore,  that  craniotomy  on  the  living  foetus  is  to  be  super- 
seded by  the  conservative  operation." 


THE  HOSPITAL  FOR  CONTAGIOUS  DISEASES. 

LETTER    ADDRESSED    TO    THE    COMMISSIONERS    OF    THE 
DISTRICT    OF    COLUMBIA,    JUNE,    1893. 

Preli]minary  to  the  selection  of  a  site,  adoption  of 
plans,  and  construction  of  the  buildings,  the  Commissioners 
should  determine  the  forms  of  disease  to  be  admitted.  Pre- 
sumably the  three  most  prevalent  and  dangerous  forms — 
diphtheria,  scarlet  fever,  and  measles — W'Ould  be  named. 
Typhoid   fever  and  venereal    diseases  can   be  as  well  and 


292  ESSAYS  AND  ADDBESSES. 

perhaps, better  cared  for  in  other  hospitals.  Mumps,  chicken- 
pox,  and  whooping-cough  are  so  rarely  serious  and  are  com- 
paratively so  free  from  danger  as  not  to  need  hospital  accom- 
modations. Cholera,  typhus  and  relapsing  fevers  are  such 
infrequent  visitors  to  this  locality,  the  latter  never  having 
invaded  this  city,  and  the  cholera  not  since  1832,  that  it 
would  seem  entirely  unnecessary  to  consider  them  in  connec- 
tion with  this  hospital.      Smallpox  is  provided  for. 

The  diseases  usually  classed  as  contagious  diseases,  with 
the  exception  of  smallpox,  are  far  more  prevalent  among  chil- 
dren under  ten  years  of  age.  Therefore,  it  must  follow  that 
all  institutions  established  for  the  care  and  maintenance  or 
for  hospital  management  and  treatment  of  children  under  ten 
years  of  age,  to  which  the  immune  and  susceptible  are  alike 
admitted,  must  always  be  liable  to  invasion  when  such  dis- 
eases are  prevalent  in  surrounding  or  adjacent  communities. 
Such  institutions  are  not,  however,  more  often  or  necessarily 
the  original  focus  for  dissemination  than  a  focus  invaded  by 
dissemination  from  other  foci  in  adjacence,  proximity,  or  by 
conveyance,  either  direct  by  personal  intercourse  or  indirect 
by  infection  of  the  atmosphere.  In  fact,  every  private  resi- 
dence in  every  town  and  city  in  which  are  domiciled  one  or 
more  susceptible  persons,  especially  children  under  ten  years 
of  age,  becomes  during  the  prevalence  of  these  maladies  a 
focus  inviting  invasion,  and  when  invaded  a  focus  dissemi- 
nating the  contagion. 

It  is  also  well  established  that  places,  buildings,  and  in- 
stitutions where  numbers  of  well  but  susceptible  children  daily 
or  weekly  congregate,  coming  as  they  usually  do  from  locali- 
ties and  many  private  residences  of  the  same  city,  may  con- 
stitute foci  for  the  dissemination  of  contagious  diseases  of  far 
greater  frequency  and  wider  prevalence  than  the  hospitals, 
where  only  the  victims  are  admitted  and  detained  in  quaran- 
tine until  all  danger  of  infection  has  passed.  In  fact,  all 
schools,  public,  private,  and  parochial;  picnics,  garden-par- 
ties,  social    entertainments,   amusements    of   all    kinds,    and 


ESS  A  YS  A  Nl)  A  l>  I>  It  ESSES.  293 

funerals  of  those  (]ea<l  of  Ww.  (Hhcmh'!,  wlutn'  \v<Jl,  l)iit  siisffj)- 
tiblc,  f'liildrcn  in;iy  aHSctiihIc  may  constiliitf;  foci  for  tlio  dis- 
seminatioii  of  any  of  the  discasos  known  as  fontagions  and 
infectious,  when  the  disease  is  present  in  thf  locality,  district, 
or  houses  from  which  the  oliildrcn  may  come.  In  any  such 
assemblage  more  children  may  be  infected  and  wider  spread 
epidemics  may  find  their  beginning  than  could  be  traced  to  a 
properly  constructed  and  managed  hospital  filled  to  its  utmost 
capacity  and  located  in  close  proximity  to  the  most  densely 
populated  parts  of  any  city.  It  is  not  improbable  that  the 
conveyance  of  the  victims  through  the  streets  of  a  city  to  a 
hospital  remotely  located  from  the  mass  of  population  would 
be  even  more  dangerous  (certainly  to  the  patients)  to  the 
community  than  the  hospital  could  be,  even  though  located  in 
the  very  midst  of  the  most  thickly  populated  part  of  the  city. 

Epidemics  of  contagious  diseases  vary  in  prevalence,  in- 
tensity, and  mortality.  During  such  epidemics  many  suscep- 
tible persons  escape.  Those  escaping  may  reside  in  the  same 
block,  on  the  same  square,  on  opposite  sides  of  the  same  street, 
in  adjoining  and  even  in  the  same  house  with  the  victim. 
Such  epidemics  are  far  less  prevalent  in  this  than  in  other 
cities  because  of  the  greater  width  of  the  streets  and  avenues, 
numerous  parks  and  unoccupied  spaces,  consequent  freer  ven- 
tilation, dilution  and  diffusion  of  the  poison. 

All  hospitals  for  the  treatment  of  sick  children  are  liable 
to  invasions  of  contagious  diseases  when  such  diseases  are 
prevailing  in  the  community  contiguous  thereto,  and  in  many 
of  such  hospitals  wards  are  provided  for  the  isolation  of  such 
eases.  In  some  these  wards  are  in  the  hospital-building,  but 
most  frequently  they  are  outside  of  the  hospital-building  in 
the  iuclosure  in  near  proximity  to  the  other  buildings  and 
under  the  hospital  management.  As  yet,  it  has  uot  been 
shown  that  such  arrangement  for  the  care  and  treatment  of 
contagious  diseases  has  proved  detrimental  to  the  health  of 
susceptible  persons  in  adjacent  and  contiguous  parts  of  the 
city,   nor  has  it  been   claimed  that  such  institutions  have 


294  ESSAYS  AND  ADDRESSES. 

become  foci  for  the  dissemiDation  of  such  diseases.  In  fact, 
the  explosions  of  contagious  diseases  in  hospitals  for  sick  chil- 
dren have  usually  been  traced  to  the  admission  of  visitors 
from  infected  houses  and  districts. 

The  fact  has  been  established  by  the  investigations  of  the 
highest  German  and  English  authorities  that  hospitals  for 
diphtheria,  scarlet  fever,  and  measles  located  300  feet  from 
inhabited  houses  are  absolutely  safe. 

It  may  be  asserted  without  fear  of  contradiction  that  not 
one  case  of  either  of  these  diseases  has  been  traced  to  a  prop- 
erly constructed  and  managed  hospital  for  contagious  diseases 
located  300  feet  distant.  In  many  cities  in  this  country  and 
abroad  they  are  located  much  nearer. 

The  foregoing  is  a  simple  statement  of  the  conditions, 
circumstances,  and  facts  relating  to  the  selection  of  a  site 
for  the  hospital,  and  lead  to  the  conclusion  that  it  might  be 
located  upon  any  unoccupied  square  or  reservation  within 
the  limits  of  the  city  without  detriment  to  the  health  of  the 
surrounding  population  or  injury  to  commercial  interests  be- 
yond that  pertaining  to  every  eleemosynary  institution  and 
hospital. 

A  hospital  for  contagious  diseases,  separate  a^nd  distinct 
in  its  management,  will  prove  to  be  an  expensive  establish- 
ment because  of  the  necessity  of  continuous  complete  equip- 
ment for  every  emergency.  The  occurrence,  prevalence,  and 
succession  of  epidemics  or  sporadic  cases  cannot  be  predeter- 
mined. Past  experience  would  point  to  the  conclusion  that 
for  the  greater  part  of  each  year  in  the  near  future  there 
would  not  be  any  patients.  The  hospital  must  be  kept  in 
readiness  for  patients ;  patients  cannot  be  made  for  the  hos- 
pital ;  convenience,  economy  of  administration  and  equip- 
ment, as  well  as  humanity,  would,  therefore,  locate  the  estab- 
lishment in  safe  proximity  to  some  well-conducted  and 
equipped  hospital  and  place  its  management  under  the  direc- 
tion and  control  of  the  same,  so  that  the  current  expenses 
when  idle  would  be  reduced  to  the  minimum,  and  as  the 


A'.S'S'/I  )',S'  AND  A  I)  I)  It  FOSSES.  205 

necesHities  increase  all  stores,  liospital-siipplics,  nnrsfs,  and 
medical  care  could  Ix;  obtained  from  tlic  iriHtitntion  in 
control. 


THE  MEDICAL  SOCIETY  OF  THE  DISTRICT  OF 
COLUMBIA. 

ADDRESS  OF  THE  PRESIDENT  AT  THE  SEVENTY-FIFTH  ANNI- 
VERSARY '  OF   THE    MEDICAL   SOCIETY    OF   THE 
DISTRICT   OF   COLUMBIA,  DELIVERED 
FEBRUARY    16,    1894. 

Ladies  and  Gentlemen  :  Inasmuch  as  the  occasion 
which  has  brought  us  together  to-night  is  one  of  those  his- 
toric events  which  emphasize  the  permanency  of  this  city 
as  the  capital  of  a  great  and  powerful  nation,  and,  following 
so  quickly  the  commemoration  of  the  centennial  anniversary 
of  the  laying  of  the  corner-stone  of  the  Capitol,  identifies  the 
history  of  medicine  with  that  of  the  city  from  its  foundation 
to  the  present  time,  I  will  venture  to  recall  your  attention  to 
such  historic  data  as  will  establish  the  coincident  relation  of 
the  medical  profession  in  this  city  with  its  early  history, 
development,  and  present  prosperous  condition. 

On  the  9th  of  July,  1790,  Congress  passed,  and  on  the 
16th  of  the  same  month  \yashingtou  approved,  the  Act 
"  establishing  the  temporary  and  permanent  seat  of  the 
government  of  the  United  States  on  the  River  Potomac." 
In  March,  1791,  Washington  issued  a  proclamation  defining 
the  limits  of  the  new  federal  territory  and  directing  the  com- 
missioners and  engineer  to  proceed  with  the  preparation  of 
the  plan  of  the  government  city.  On  the  18th  of  September, 
1793,  the  corner-stone  of  the  Capitol  was  laid  by  Washing- 
ton, and  on  the  third  Monday  of  November,  1800,  the  Con- 
gress of  the  United  States  began  its  first  session  in  the  Capitol 
in  this  city. 


296  ESSAYS  AND  ADDRESSES. 

When  Drs.  Samuel  Brown  and  John  Crocker  settled  here 
"  the  territory  was  inhabited  by  a  few  farmers,  their  servants, 
and  perhaps  some  tradesmen  and  fishermen."'  With  the  set- 
tlement of  Frederick  May,  a  native  of  Boston  and  a  graduate 
of  Harvard  University,  in  1795,  medicine  as  a  science  had  its 
beginning  in  the  city  of  Washington.  Others  followed,  and 
in  1815  there  were  nine  physicians  and  two  practising  apothe- 
caries.^ The  first  associate  assemblage  of  physicians  of  this 
city  took  place  in  1813,  called  by  public  advertisement,  "  to 
take  suitable  notice  of  the  death  of  Dr.  Benjamin  Rush,"  the 
father  of  American  medicine,  and  "  to  appropriately  com- 
memorate his  life  and  professional  services."^ 

Perhaps  prior,  but  certainly  during  several  years  succeed- 
ing this  date,  the  influx  of  charlatans  and  pretenders  was  so 
extraordinary,  and  such  injuries  and  wrongs  were  perpetrated 
by  them  upon  citizens,  that  the  qualified  physicians  began  to 
consider  and  discuss  methods  of  procedure  and  organization 
by  which  the  community  could  be  protected  from  such  wrongs 
and  informed  of  the  qualification  of  those  fitted  to  practise 
the  healing  art.  Those  efforts  culminated  in  a  petition  to 
Congress  in  1818,  signed  by  twenty-one  physicians,  for  the 
charter,  which  was  granted  and  approved  by  President  Mon- 
roe on  the  16th  of  February,  1819. 

We  have  invited  you  here  to-night  to  unite  with  us  in 
commemoration  of  that  event.  And  now  that  you  know 
that  those  noble  founders  were  animated  by  the  highest 
inspiration  of  Christian  philanthropy  and  beneficence  in 
the  foundation  of  a  medical  society  which  has  lived  through 
a  period  of  seventy-five  years,  contemporaneous  in  history 
with  the  federal  city  and  the  government,  you  will  appre- 
ciate and  honor  the  pride  we  take  in  giving  expression  to 
our  praise  and  gratitude  in  memory  of  those  noble  men  on 
this  anniversary-night. 

From  twenty-one  it  has  grown  to  an  active  resident  mem- 

1  Anniversary  address,  by  Dr.  J.  M.  Toner,  September  26,  1S66.       2  n,id.        s  Ibid. 


h\SSy\  VS  AM)  ADDIIKSSKS. 


207 


l){!r,4lii))  of  two  liiin(]r(!(l  and  foiirf/^cn,  of  wlioiii  hut  tlirofj 
have  passed  the  aj^e  of  allotted  hfetiinc,  ;iiid  il.s  .senior  in 
memhcrship  is  a  decade  younj^er  than  it.  I  lujed  not,  then, 
tell  yon  that  in  physical  vigor  and  intellectual  alertness  it  is 
now  in  the  very  prime  of  mature  life. 

Such  youth  and  vigorous  manhood  have  not  always  char- 
acterized its  membership.  The  average  age  has  diminished 
with  time  and  the  increase  of  numbers.  Among  the  honored 
dead  twenty-eight'  lived  beyond  threescore  and  ten,  of  whom 
six  were  founders;  nineteen  died  at  ages  between  fifty  and 
sixty-three  years  after  the  date  of  graduation;  and  .seven 
held  continuous  membership  in  this  Society  for  periods  of 
fifty  to  sixty-three  years. 

The  average  age  of  those  venerable  decedents  was  seventy- 


(1) 

No.  Of 

No.  Of 

Date  of 

Date  of 

years 

vears 

admis- 

gradu- 

Date  of 

living 

of  con- 

sion tti 

lation  in 

death. 

after 

tinuous 

Founders.    Age. 

Society 

medicine 

gradu- 
ation. 

mem- 
beiBhip 

Antisell,  Thomas 

1859 

1839 

1893 

54 

34 

1 
76 

Blake,  John  B. 

1826 

1824 

1881 

67 

85 

81 

Bohrer,  B.  S. 

1817 

1810 

1862 

52 

45 

Founder.       77 

Borrows,  Joseph 

1838 

1828 

1889 

61 

51 

82 

Catbush,  Edward 

1820 

1794 

1843 

49 

23 

71 

Condit,  H.  F. 

1838 

1830 

1893 

63 

55 

89 

Dawes,  Frederick 

1838 

1882 

74 

Dick,  E.  C. 

1817 

1782 

1825 

43 

8 

75 

Fairfax,  Orlando 

1830 

1829 

1882 

53 

51 

76 

Hall,  J  C. 

1838 

1827 

1880 

53 

42 

75 

Howard,  F. 

1842 

1841 

1888 

47 

46 

77 

Jones,  William* 

1817 

L.M.C.F. 

1867 

50 

50 

Founder.   '    77 

Johnson,  Richmond 

1834 

1826 

1874 

48 

40 

I    83 

Liebermun.  C.  H. 

1844 

1836 

1886 

50 

42 

!    74 

Liudslev,  Harvey 

1834 

1828 

1889 

61 

55 

'    85 

Magruder,  llezekiah 

1850 

1826 

1874 

48 

24 

!    70 

Mav,  Frederick 

1817 

1795 

1847 

52 

30 

Founder.       74 

May,  J.  F. 

1S40 

1834 

1891 

57 

51 

;    80 

Mc\Villiam,  Alex. 

1817 

1850 

33 

Founder,    i    75 

Patze,  Adolphus 

1864 

1838 

1886 

48 

22 

82 

Riley,  Joshua 

1827 

1824 

1875 

51 

48 

75 

Ritchie,  Joshua 

1840 

1839 

1887 

46 

47 

72 

Tyson,  S.  E. 

1848 

1832 

1883 

51 

35 

1    74 

Tvler.  Grafton 

1846 

1833 

1884 

51 

38 

73 

Walsli,  Joseph 

1843 

1843 

1879 

36 

31 

73 

Warlield,  P.* 

1817 

L.M  C.F. 

1856 

39 

Founder.       76 

Worthiugtou,  C. 

1817 

1782 

18.36 

54 

39        Founder.        77 

Young,  Noble 

1838 

1828 

1883 

00 

45              j    75 

*  Licentiate  of  the  Medical  and  Chirurgical  Faculty  of  Marvland. 


298  ESSAYS  AND  ADDBESSES. 

six  and  one-half  years,  the  youngest  of  whom  died  at  seventy, 
in  1874,  and  the  last  at  eighty-nine,  in  1893.  In  the  primi- 
tive era  of  medicine  in  this  city  and  during  the  early  history 
of  this  Society  the  life  of  the  general  practitioner  could  not 
have  been  less  arduous  than  since.  Many  of  them  began 
life  when  the  practice  of  medicine  was  primitive  and  unre- 
munerative  in  a  community  struggling  with  poverty  in  the 
development  of  a  new  city.  It  is  true  that  the  average  life- 
time of  the  medical  is  much  less  than  of  either  the  legal  or 
the  clerical  profession,  but  this  general  law  of  vital  statistics 
fails  to  explain  the  average  youth  of  the  present  membership, 
which  represents  five  of  the  eight  decades  of  the  life-history 
of  this  Society.  These  data  are  somewhat  phenomenal,  and 
perhaps  without  special  significance ;  nevertheless,  they  em- 
phasize the  fact  that  the  pursuit  of  the  art  of  healing  is  not 
conducive  to  longevity,  and,  while  the  average  life  of  men 
in  general  is  increasing,  that  of  the  medical  profession  is  de- 
creasing. With  an  average  age  of  forty-three  and  one-half 
years,  and  a  prospective  death-rate  of  57  per  cent,  under 
sixty-five,  the  problem  of  life  and  longevity  is  of  sufficient 
magnitude  to  command  your  attention.  It  will  not  do  to 
ascribe  this  high  death-rate  during  the  prime  of  life  and 
manhood  wholly  to  mental  worry,  sleepless  tire,  and  inade- 
quate remuneration,  for  these  find  compensation  in  the 
assured  livelihood,  conscious  pleasure,  and  consolation  of 
duty  well  done.  Whether  referable  to  such  aesthetic  or  to 
graver  considerations,  the  time  has  surely  come  when  the 
causes  of  the  comparative  low  average  life  of  men  engaged  in 
the  science  of  saving  and  prolonging  life  should  be  intelli- 
gently and  definitely  ascertained.  Those  few — thirteen  in  all 
— who  have  reached  and  passed  the  age  of  highest  death-rate 
are  equally  sure  of  the  inevitable,  but  can  offer  their  juniors 
the  consolation  of  their  good-wishes. 

The  elder  May  came  here  in  1795,  five  years  before  the 
transfer  of  the  government  to  this  city.  He  was  a  pioneer 
who  prepared  the  way  for  others,  and  the  founder  through 


ESSAYS  AND  A  1)1  HiESSKS.  299 

whose  professioiinl  \\U\  i\u\  history  of  iiicdicinr!  in  this  city 
during  the  years  antedating  the  organization  of  this  Society 
can  bo  traced  tlirough  inonilxM'shij)  to  and  before  the  estJib- 
lishment  of  the  government  here  and  continuously  with  its 
growth  and  development  down  to  the  present  time.  His 
son,  John  l^'rederick,  was  born  and  began  the  practifx;  of 
medicine  in  this  city  and  died  a  member  of  this  Society,  at 
the  age  of  eighty  years,  leaving  a  son,  now  an  active  resident 
member.  In  this  family  the  continuity  of  membership  has 
been  unbroken  from  its  organization  to  the  completion  of  its 
seveuty-lifth  anniversary.  This  Society,  then,  claims  a  life- 
time beginning  before  the  government  at  Washington  and 
coeval  with  the  foundation  of  the  city  on  the  River  Potomac. 

The  Medical  Society  of  the  District  of  Columbia  is  the 
youngest  of  twelve  medical  societies  in  this  country  now  in 
existence  which  have  reached  and  passed  the  seventy-fifth 
year  of  continuous  active  life,  and  is  the  oldest,  if  not  the 
first,  scientific  body  chartered  by  an  Act  of  the  Congress  of 
the  United  States.  Ten  of  its  founders  were  natives  of 
Maryland,  four  of  Virginia,  two  of  Massachusetts,  two  were 
born  within  the  present  limits  of  the  District  of  Columbia, 
and  of  three  the  nativities  are  unknown.  In  personal  lineage 
it  is  confined  to  three  of  the  original  thirteen  States,  but  as  a 
scientific  body  it  claims  ancestral  descent  from  eleven  progeni- 
tors, who  are  present  by  representation  with  us  to-night.  It 
is,  however,  the  natural  and  direct  heir  of  the  Medical  and 
Chirurgical  Faculty  of  Maryland. 

With  such  an  ancestry,  dating  back  to  1766,  during  the 
period  of  colonial  discontent  and  strife;  a  foundation  spring- 
ing from  the  noble  impulses  of  humanity  and  inspired  by 
motives  of  high  professional  responsibility;  fulfilling  in  its 
corporate  capacity,  throughout  its  long  life,  the  charter-decla- 
ration to  promote  and  disseminate  medical  and  surgical  knowl- 
edge, and  keeping  abreast  with  the  progress  of  a  science  which 
has  made  medicine  the  handmaid  of  religion,  do  you  wonder 
that  the  successors  of  those  who  save  birth  to  this  Societv, 


300  -  ESSAYS  AND  ADDRESSES. 

now  living  iu  a  community  representing  the  intelligence, 
civilization,  progress,  and  power  of  a  nation  of  sixty-five 
millions  of  free  people,  should  invite  you  to  this  reunion  to 
tell  you  how  faithfully  they  have  kept  the  promise  of  its 
founders,  and  to  unite  with  them  in  giving  thanks  and  praise 
to  that  Providence  which  rules  the  universe? 

The  period  comprising  the  years  from  1819  to  1894  has 
been  one  of  marvellous  progress  in  science,  literature,  art, 
and  in  all  that  pertains  to  Christian  civilization.  The  village- 
city  with  its  domain  of  farms,  scattered  homes,  graphic  streets 
and  avenues,  "  squares  in  morasses"  and  "  obelisks  in  trees," 
has  become  the  metropolis  of  a  munificent  nation,  under  whose 
supervision  it  has  grown  into  a  city  surpassing  in  beauty  and 
rivalling  in  attractiveness  the  more  favored  cities  of  both  the 
old  and  the  new  world,  and  holding  together  in  one  com- 
pact community  a  cosmopolitan  population,  where  education 
and  culture  need  neither  the  blazonry  of  titular  insignia,  the 
heraldry  of  ancestral  distinction,  nor  the  glamour  of  wealth 
to  command  position  and  influence. 

During  the  same  period  medicine,  here  and  elsewhere, 
advancing  along  the  lines  of  pathological  research  and  physio- 
logical therapeutics,  has  escaped  the  era  of  hypothesis  and 
speculation,  and  now  as  a  science  of  precision  and  demonstra- 
tion commands  the  respect  and  homage  of  the  civilized  world. 
Now,  as  heietofore  and  everywhere,  it  is  foremost  in  charity, 
unselfish  in  devotion  to  the  welfare  of  public  health,  mag- 
nanimous under  public  and  private  wrongs,  and  generous  to 
a  fault  in  unremunerative  perils  and  responsibilities. 

But  even  this  is  not  the  full  measure  of  its  philanthropy. 
The  mission  of  preventive  medicine  and  sanitary  science  will 
not  be  attained  until  the  causes  of  disease  are  eradicated  and 
death  is  limited  to  the  ailments  to  which  flesh  is  necessarily 
heir  and  the  processes  of  natural  waste  and  decay.  How 
soon,  if  ever,  this  may  be  accomplished  remains  with  the 
laity ;  medicine  will  continue  the  pursuit  with  the  zeal  and 
courage  of  a  science  which  seeks  the  welfare  of  mankind 


ESSAYS  ANI>  A  f) DRESSES.  .'JOl 

ratlidr  tlian  jilucc  mikI  ^()l•tlllK^  TIk;  nu'dical  is  tlic  only 
profession,  trade,  or  oc(;upation  which  seeks,  by  the  progres- 
sive attainiruMit  of  its  ultimate;  ohjcct,  tlie  fontinnon.H  deerease 
of  eniolmuent. 

One  of  the  most  pleasing  incidents  of  this  occasion  is  the 
presence  of  representatives  of  the  eleven  ancestral  societies, 
the  oldest  of  which  was  organized  in  176G,  in  the  l^tate  of 
New  Jersey.  This  exhibition  of  fraternity  is  an  exemj)lifi- 
cation  of  that  beneficent  spirit  which  dominates  the  medical 
profession  and  makes  kindred  of  ns  all. 

Ilonored  colleagues  who  will  follow  me  will  tell  you  of  its 
achievements  in  science  and  of  its  educational  and  charitable 
fonndations.  I  have  only  to  conclude  with  a  few  words 
addressed  to  ray  colleagues  and  juniors. 

It  could  not  have  occurred  before,  and  never  can  occur 
again,  that  the  senior  in  membership  will  be  nnaniraously 
re-elected  to  the  presidency  on  the  forty-fifth  anniversary  of 
his  membership  and  preside  at  the  commemoration  of  the 
seventy-fifth  anniversary  of  this  Society.  Such  a  unique  com- 
pliment cannot  be  acknowledged  in  words  which  will  com- 
pletely and  fittingly  convey  the  gratitude  I  feel  for  such 
expression  of  personal  and  professional  regard.  At  the  cen- 
tennial reunion  some  one  of  you  will  stand  where  I  now 
stand,  upon  whom  will  devolve  the  duty  which  thrills  me 
with  pleasure  to-night.  In  the  enforced  retirement  which 
must  come  soon,  I  will  cherish  the  hope  that  each  one  and 
all  of  you  may  live  to  celebrate  the  golden  wedding-day  of 
professional  life,  and  in  communion  with  the  Saviour  of  man, 
who  was  first  to  heal  the  lame,  the  halt,  and  the  blind. 

AFTEE-DINNER  SPEECH   AT   THE    BANQUET, 
FEBEUARY    16,    1894. 

Gentlemen  :  In  the  olden  time,  during  the  period  of 
primitive  medicine  and  embryotic  condition  of  this  city, 
about  the  time  when  Tom  Moore,  in  his  rhapsody  on  the  city 
and  national  government,  wrote: 


302  ESSAYS  AND  ADDRESSES. 

"  In  fancy  now  beneath  the  twihght  gloom, 
Come,  let  me  lead  thee  o'er  this  ■'  second  Rome,' 
Where  tribunes  rule,  where  dusky  Davi  bow, 
And  what  was  Goose  Creek  once  is  Tiber  now  : 
This  embryo  capital,  where  fancy  sees 
Squares  in  morasses,  obelisks  in  trees  ; 
Which  second-sighted  seers  e'en  now  adorn 
With  shrines  unbuilt,  and  heroes  yet  unborn,    . 

Though  naught  but  woods  and  J N  they  see, 

Where  streets  should  run,  and  sages  ought  to  be." 

The  nine  physicians  and  two  practising  apothecaries,  to- 
gether with  others  from  Georgetown  and  Alexandria,  held 
their  business  meetings  in  the  hostelries  of  that  early  date 
known  as  Tennyson's  and  Strother's  taverns.  If  they  ever 
assembled  in  social  reunion,  our  distinguished  historian,  Dr. 
Toner,  has  failed  to  inform  us ;  but  we  do  know  there  was 
no  banquet-hall  in  which,  like  ourselves,  they  could  assemble 
to  greet  and  bid  welcome  their  friends  and  each  other  around 
the  festive  table.  How  different  now  !  Seventy-five  and  more 
years  have  passed,  and  we  have  come  together  in  number  ten 
times  more  to  bid  welcome  to  guests  from  different  places, 
together  with  others  from  our  midst,  and  to  make  merry  our- 
selves in  a  reunion  of  reason  and  flow  of  soul.  While  bowing 
in  profound  sorrow  for  those  who  have  gone  before,  we  rejoice 
in  being  among  the  living  to-day,  in  that  we  may  commemo- 
rate their  good  deeds  and  virtues  in  seeking  relief  from  dull 
care,  weary  toil,  and  sleepless  vigilance,  in  pastimes  and  pleas- 
ures and  "  learn  the  luxury  of  doing  good."  And  if  Tom 
Moore,  with  his  good  friend,  Thomas  Hume,  in  the  rugged 
days  of  yore,  could 

Sit  at  evening  tide  beneath  the  western  stars, 
Softly  sigh,  like  lovers,  through  their  sweet  cigars. 
And  fill  the  ears  of  some  consenting  she 
With  puffs  and  vows,  with  smoke  and  constancy, 

why  may  not  we,  in  the  hour  of  our  triumph,  though  old  in 
years  but  young  in  flesh,  bid  our  sorrows  ' '  a  brief  farewell," 
and  with 

"  Pleasure  and  action  make  the  hours  seem  short  " 

while  we 

"  Sit  to  chat  as  well  as  eat  " 


/':SSA  VS  AND  ADD  It  ESSES.  ,'{0.3 

in  sonial  reunion  wit.li  our  micstH,  wlio  liiivc  !)roiif.^ht  with  tliorn 
the  paternal  and  fraternal  eongral illations  of  our  Hires  and 
brothers,  and  join  with  ns  in  makinjjc  active  and  giving; 
spirit  to  the  hopes  of  a  future  more  brilliant  than  the  past? 

For  these  opj)ortnnities  we  owe  a  debt  of  lasting  gratitude 
to  the  city  of  our  home  and  the  government  under  whieli  we 
live.  With  their  |)rogress  and  development  we  have  grown 
in  number  and  power,  TJnder  the  fostering  care  of  the 
general  and  municipal  governments  and  energy  of  its  citizens 
this  eity  of  the  nation  and  heart  of  its  political  life  has  become 
the  most  desirable  eity  of  residence  in  this  great  and  ])opulou8 
country.  The  inchoate  village  of  a  century  ago,  now  a  city 
with  its  beautiful  streets  and  avenues,  flowing  fountains,  and 
decorated  parks  which  adorn  the  landscape  at  every  turn  \vith 
flowers,  foliage,  and  sward,  is  but  the  promise  of  what  it  is  to 
be  in  the  future.  And  now  let  us,  here  assembled  in  loving 
gratitude,  plight  the  best  energies  of  our  lives  and  services  in 
promotion  of  its  healthfulness  and  the  welfare  of  its  citizens. 

Just  seventy-five  years  ago  this  Society  held  its  first  meet- 
ing in  the  council-chamber  of  the  city,  and  thereby  plighted 
their  fiiith  to  live  together  as  mutual  helpmates  of  each  other. 
I  rejoice  that  it  has  fallen  to  my  lot  to  proclaim  here,  in  the 
presence  of  both  contracting  parties,  on  this  diamond  wedding- 
night,  that  the  promise  has  been  kept.  I  know  not  which 
was  the  bride  nor  which  was  the  groom  on  that  auspicious 
occasion,  but  for  the  present  I  yield  the  role  of  the  better- 
half  to  my  friend  on  my  left,  the  Honorable  John  W,  Ross, 
President  of  the  Board  of  Commissiouei's  of  the  District  of 
Columbia. 


304  ESSAYS  AND  ADDRESSES. 


ASSOCIATION  OF  MILITARY  SURGEONS. 

ADDRESS  OF   WELCOME  TO   THE  ASSOCIATION   OF   MILITARY 
SURGEONS,  DELIVERED  AT  WASHINGTON,  MAY  1,  1894. 

Mr.  President  and  Gentlemen:  I  am  here,  as  the 
representative  of  the  Medical  Society  o£  the  District  of 
Columbia,  to  extend  to  you  the  right  hand  of  fraternal 
fellowship  and  comity  of  a  society  which  is  one  of  twelve 
medical  societies  in  this  country  that  have  passed  the  age 
of  seventy-five  years  in  active  and  continuous  existence, 
and  to  bid  you  welcome  to  the  city  of  its  birth,  in  which 
it  has  lived  these  many  years,  contemporaneous  in  history, 
progress,  and  power  with  the  growth,  development,  and 
prosperity  of  this  metropolis,  and  now,  as  heretofore,  com- 
mands the  respect  and  confidence  of  the  community.  Its 
beginning  was  inspired  by  that  spirit  of  beneficeuce  which 
bound  its  founders  together  in  one  compact  body  of  such, 
and  only  such,  physicians  as  were  qualified  to  practise  the 
healing  art  and  to  promote  and  disseminate  medical  and  sur- 
gical knowledge,  that  the  people  might  be  protected  from  the 
wrongs  and  injuries  inflicted  by  charlatans  and  pretenders. 
Throughout  its  long  life  it  has  accepted,  maintained,  and 
followed  the  maximum  of  the  Republic — "  Union,  now  and 
forever,  one  and  inseparable " — as  alike  applicable  to  the 
advancement  of  scientific  medicine  as  to  the  maintenance  of 
the  union  of  these  States.  With  firm,  steadfast,  and  un- 
wavering devotion  to  the  highest  aims  of  medical  science,  it 
has  successfully  passed  through  many  vicissitudes  of  political 
agitation,  bid  defiance  to  assaults  from  without,  and  outlived 
schisms  in  its  own  membership. 

It  passed  through  the  period  of  internecine  strife  and 
emerged  from  that  conflict  of  havoc,  bloodshed,  and  waste 
of  treasure  increased  in  number  and  power,  and  stands  here 


ESSAYS  AND  A  I)I)IIF,SSICS.  ,'}05 

to-day  to  bid  wcN-oiik!  to  lliis  organization,  vvlii<-li  is  ihc  oiit- 
growtli  of  that  (loveloptiicnt,  and  the  fit'Ht  to  iinitc  in  organized 
and  coheHivc  effort  to  ntilize,  promote,  advance,  and  perfect 
the  science  of  military  medicine  and  surgery  ;  and  lest  it  l)e 
said  here  and  now  that  if  those  armies  could  have  l)een 
equipped  with  such  men  and  appliances  as  they  could  he  to- 
day, the  missiles  of  warfare;  would  have  found  many  thou- 
sands less  of  victims,  and  untolds  millions  of  treasure 
would  have  been  saved.  The  war  gave  impetus  to  new 
thought,  to  new  and  broader  conceptions  of  military  duty, 
and  the  achievements  of  modern  American  surgery  owe  their 
inception  to  the  opportunities  and  lessons  which  you  and  others 
have  expanded  and  applied  in  the  interest  of  a  common  hu- 
manity. And  now  this  country  holds  the  sceptre  of  siirgery. 
In  1858  the  lamented  Harvey  Lindsley,  in  his  address  of 
welcome  to  the  American  Medical  Association,  then  assem- 
bled in  this  city,  after  giving  expression  to  his  regret  and 
mortification  that  the  city  was  so  barren  of  all  that  would 
interest  the  votaries  of  medical  science  and  attract  the 
pleasure-seeker  and  tourist,  be  added,  in  language  that 
reads  like  the  inspiration  of  prophecy,  ''  the  day  is  not 
far  distant  .  .  .  when  by  the  liberality  of  a  great 
people  our  public  buildings,  our  literary  and  scientific  in- 
stitutions, our  national  parks  and  botanic  gardens  will  be 
worthy  of  the  grand  metropolis  of  a  nation  which,  i>erhaps 
within  the  next  half-century,  will  be  the  most  populous, 
powerful,  and  wealthy  in  Christendom."  I  heard  those 
words  thirty-six  years  ago,  and  I  stand  here  to-day,  repre- 
senting the  same  organization,  to  bid  you  welcome  to  the 
Capital,  in  which  every  prediction  has  been  realized,  and 
yet  it  has  but  reached  the  stage  of  growth  and  development 
which  is  but  the  promise  of  what  it  is  to  be  in  the  future, 
when,  as  the  nation's  Capital,  reflecting  its  power,  glory, 
and  wealth,  it  will  surpass  in  all  that  peitains  to  art,  litera- 
ture, science,  civilization,  and  human  comforts  and  luxuries 
the  most  favored  metropolis  of  the  civilized  world. 

20 


306  ESSA  YS  AND  ADDRESSES. 

That  you  may  better  appreciate  the  modesty  of  Lindsley's 
description  and  the  fulness  of  his  prophecy,  let  me  tell  you 
that  when  I  came  here,  some  years  earlier,  there  were  but 
two  streets  partly  paved,  but  few  sidewalks  paved  beyond 
the  centre  of  the  city,  they  being,  for  the  most  part,  improved 
by  midway  ridges  of  gravel  and  coal-ashes,  but  there  were 
long  stretches  of  zigzag  paths  along  which  pedestrians  could 
walk  only  in  single  file.  There  were  no  telephones,  street 
tramways,  nor  cable  and  trolley  systems  of  rapid  transit  to 
fill  the  wards  of  an  emergency  hospital  and  encourage  the 
incidental  sciences  of  embalming  and  undertaking;  street- 
transportation  was  limited  to  a  few  hotel  omnibuses,  through- 
line  coaches,  a  few  hackney  carriages,  a  corps  of  night-liners, 
as  now,  and  Shank's  mare.  From  the  capital  to  Georgetown 
several  antiquated  buses  ran  at  irregular  intervals  along 
Pennsylvania  Avenue.  The  fare  for  a  ride  each  way  for 
each  passenger  was  one  eleven-penny  bit,  but  a  colored  nurse 
or  maid  could  not  get  a  ride  at  any  price  unless  she  had  some- 
body's white  baby  in  her  lap. 

The  back  yards  of  many  private  dwellings  were  decorated 
with  pigstys,  cowsheds,  and  pens  for  the  gangs  of  unyoked 
geese.  During  the  day  the  animals  and  fowls  roamed  at 
will,  singly  or  in  herds  or  flocks,  through  the  streets  and 
over  the  fields  in  lordly  insolence.  Garbage  was  thrown 
into  the  carriageways  or  back  alleys,  and  swine  were 
the  privileged  and  protected  scavengers.  To  jostle  against 
or  drive  over  one  of  these  municipal  functionaries,  when 
out  on  his  tour  of  sanitary  inspection,  incurred  a  cash 
penalty  or  brief  servitude  in  the  workhouse.  The  swine- 
nuisance  dominated  the  city  authorities  until  a  gentleman 
was  knocked  down  and  killed  by  one  running  between  his 
legs,  and  the  family  milch-cows  were  finally  driven  to  the 
shambles  by  the  more  economical  and  adulterated  milk-sup- 
plies from  the  dairy-farms  of  Maryland  and  Virginia.  The 
goose-industry  bade  defiance  to  every  protest  until  the  robber- 
bands  learned  the  flavor  of  their  flesh.     During  that  early 


ESSA  YS  A  NI>  A  DDRICSSKS.  .307 

period  r  have  trudged  on  foot,  tliroiigli  Hiiri.shino  and  shower, 
along  the  well-beaten  paths  for  short-eiitH  acroas  the  fields 
and  thr()iii;h  the  ,slaslu:.s,  in  .search  of  houic  lonely  hut  Hifiiaffd 
over  yonder  behind  or  n(nir  l)y  some  other  (;fjiially  luidefiued 
locality,  here  and  there,  along  the  way,  driving  a  drove  of 
swine  from  their  mire  or  hustling  away  from  the  eorpf)ration 
bulls,  or  during  the  night  along  streets,  alleys,  and  by-ways 
80  dark  with  blackness  that  eyes  were  most  useful  when 
closed,  or  so  dimly  lighted  with  lard-oil  lamps  so  remotely 
separated  tiiey  seemed  like  ifjniH  fatui  enticing  one  into  the 
dismal  realms  of  hobgoblins  and  ghosts  ;  or,  perchance,  in 
some  localities — now  traversed  by  well-paved  streets  and 
avenues  adorned  on  either  side  with  palatial  residences — 
along  the  pathways  trodden  only  by  the  beasts  of  the  field. 

Then  the  war  came,  and  with  it  a  transformation  not  less 
surprising  than  the  primitive  methods  and  conditions  to 
which  I  have  referred.  The  barren  farm-  and  pasture-lands 
were  occupied  wnth  encampments,  fortifications,  parade- 
grounds,  hospitals,  wagon-yards,  mule-pens,  and  other  mu- 
nitions of  warfare.  The  streets  were  in  continuous  martial 
array  with  troops  equipped  for  the  field.  In  brief,  the 
city  was  one  great,  impregnable  fortress,  protecting  a  gov- 
ernment that  never  for  one  moment  faltered  in  courage  or 
paused  in  prosecution.  With  these  stupendous  preparations 
and  masses  of  troops  there  came  the  omnium  gatherum  of 
contrabands,  refugees,  scalawags,  camp-followers,  tramps, 
substitute  -  brokers,  wildcat  -  money  -  changers,  fiat  -  money 
people,  office-seekers  as  now,  and  last,  but  not  least,  the 
croakers  who  lived  upon  the  innocent  credulity  of  timid 
W'Omen  and  cowardice  of  malingerers  who  wanted  war  but 
somebody  else  to  do  the  fighting.  The  croaker  tarries  with 
us  yet  and  continues,  like  "  querulous  frogs  in  muddy  pools," 
to  croak.  Nevertheless,  those  of  you  who  saw  the  city  then 
will  mark  the  contrast  now.  Peace  reigns  where  martial 
law  dominated.  Progress  and  development  have  marked 
every  decade  of  the  city's  history  since  the  close  of  the  war. 


308  ESSAYS  AND  ADDRESSES. 

Now  go  where  you  may  please  along  these  beautiful  streets, 
these  avenues  of  foliage-trees,  or  out  upon  the  hilltops  that 
environ  the  city,  and  the  prospect  and  landscape  will  leave 
the  memory  of  beauty  in  nature  and  excellence  in  art.  The 
monument  in  honor  of  him  whose  name  the  city  bears  rises 
from  the  lowlands  high  into  the  space  above,  as  the  nation's 
memorial  to  him  who  was  "  first  in  war,  first  in  peace,  and 
first  in  the  hearts  of  his  countrymen ;"  the  Capitol,  in  which 
assembles  annually  the  highest  tribunals  of  legislation  and 
justice,  stands,  in  beauty  and  perfection  of  architectural 
finish,  above  the  rising  and  setting  sunj  in  token  of  the 
supreme  majesty  of  a  united  people;  the  new  library-build- 
ing approaching  completion,  with  its  gold-gilded  dome  re- 
flecting and  diffusing  the  rays  of  sunlight  and  sun-life  in 
emblematic  dissemination  of  the  knowledge  to  be  stored 
within  its  granite  walls;  the  new  naval  observatory,  far 
away  from  the  busy  mart  and  travel,  toward  the  western 
limits  of  the  city,  is  a  fitting  compliment  to  that  branch  of 
the  service  which  in  the  coming  future  will  make  the  nation 
the  master  of  the  seas;  and  right  here  in  the  open  park,  near 
by,  the  historic  mansion,  with  its  walls  hanging  in  portrait- 
ure of  the  men  who  have  filled  the  highest  office  in  the  gift 
of  a  great  and  free  people;  and  then,  too,  on  the  highland 
beyond  the  Potomac,  overlooking  the  city,  is  the  bivouac  of 
seventeen  thousand  dead,  whose  glory  will  never  fade.  All 
these,  with  many  other  commemorative  memorials,  are  but 
the  symbols  of  the  nation's  pride,  wealth,  gratitude,  prowess, 
and  majesty. 

I  cannot  detain  you  with  an  enumeration  of  the  charitable, 
educational,  and  eleemosynary  foundations  Avhich  mark  the 
progress  since  the  development  began  ;  but  must  broadly  state 
that  in  learned  and  scientific  institutions,  departments, 
bureaus,  and  great  national  libraries,  with  their  corps  of 
experts  in  every  branch  of  science,  this  city  offers  opportu- 
nities unsurpassed  in  any  city  in  this  country.  With  three 
universities   fully   equipped    and    in    successful    operation, 


ESSA  YS  A NI)  A  DDRESSES.  .•»>()!) 

aiiotlicr  vvitli  ten  millions  of  pcoph;  hcliind  it  \h  pro|)!irin;f  U> 
garner  the  liarvest  vvaitinj^  in  ripeness  for  the  sickle  and  the 
scythe. 

And  now,  coiuin;^  closer  to  that  branch  of  science  which 
most  concerns  you,  I  must  remind  yon  that  the  same  spirit 
which  has  given  impetus  to  ninv  thought  and  to  new  and 
enlarged  conceptions  of  scientific  research  has  established  in 
this  city  a  medical  library  greater  in  imraber  and  value  of 
volumes  than  any  similar  library  in  the  world,  and  an  ana- 
tomical and  pathological  museum  unsurpassed  in  the  variety 
of  its  collections.  These  foundations  are  outgrowths  of  the 
war.  They  have  been  developed  at  such  trifling  exj^ense  and 
have  contributed  so  much  to  the  promotion  and  attainment 
of  a  higher  standard  of  medical  education  that  one  feels  mean 
at  the  economy  which  seeks  to  limit  their  expansion. 

In  this  connection  let  me  vsay  here  to  you,  gentlemen,  who 
are  members  of  that  profession  whose  mission  will  not  be 
attained  until  the  causes  of  disease  are  eradicated  and  death 
is  limited  to  the  ailments  to  which  flesh  is  necessarily  heir, 
and  the  processes  of  waste  and  decay,  that  the  time  has  come 
when  it  should  assert  itself  with  all  the  vigor,  force,  and 
.power  which  a  hundred  thousand  men  united  in  a  common 
cause  can  develop  and  exercise.  There  is  not  one  family  nor 
one  voter  throughout  this  broad  land  that  someone  of  us 
cannot  reach  and  tell  the  story  of  parsimony  which  denies  to 
sanitary  science,  protective  and  preventive  medicine  the  oppor- 
tunity to  accomplish  the  full  measure  of  philanthropy.  Nay, 
even  more  ;  this  great  and  munificent  government  educates 
its  military  officers,  builds  ships  of  war,  adorns  villages  with 
costly  public  buildings,  wastes  millions  on  rivers  and  harbors, 
permits  every  quack,  pretender,  impostor,  and  fraud  to  prac- 
tise medicine  who  may  find  dupes  to  gull,  deceive,  maim,  or 
kill,  and  seeks  to  strano;le  medical  research  bv  withholdiusr 
the  trifling  pittance  of  a  hundred  journal  subscriptions.  With 
all  this  expenditure  and  waste  of  treasure  there  is  not  a  poor 
boy  or  woman  in  all  the  laud  who  can  acquire  a  first-class 


310  ESSAYS  AND  ADDBESSES. 

medical  educatiou  except  by  the  sweat  of  his  or  her  brow  or 
charity  of  some  benevolent  citizen,  and  yet  there  is  not  one 
man  in  either  the  national  or  State  Legislatures,  who,  when 
sick  and  thinks  the  devil  is  at  his  door,  waiting  for  his  de- 
parted spirit,  will  fail  to  cry  for  help,  relief,  and  time  to 
make  his  election  sure. 

In  conclusion,  I  offer  you  the  hospitality  of  our  good-will, 
and  beg  you  to  believe  us  to  be  your  good  friends. 


THE  MEDICAL  SOCIETY  OF  THE  DISTRICT  OF 
COLUMBIA. 

THE    MEDICAL   SOCIETY  OF    THE    DISTRICT   OF    COLUMBIA  IN 
1894,    WITH    SOME     IMPORTANT     RECOMMENDATIONS. 
ANNUAL    ADDRESS     OF    THE     PRESIDENT,    DE- 
LIVERED   DECEMBER    19,    1894. 

Gentlemen  :  My  first  intention  was  to  make  this  address 
a  narrative  of  some  reminiscences  of  my  early  professional 
life,  that  I  might  contrast  the  life  and  trials  of  the  beginner 
forty-seven  years  ago  and  now ;  but  after  its  preparation  I 
concluded  it  would  be  an  unjustifiable  departure  from  the 
custom  of  the  occasion,  and  an  unwarrantable  liberty  on  the 
part  of  the  chief  executive  officer  to  seek  the  discharge  of 
such  an  official  duty  with  a  narration  of  personal  reminiscences 
— especially  so,  in  view  of  the  historic  and  instructive  inci- 
dents of  the  present  year. 

The  present  has  been  an  eventful  year  in  the  history  of 
this  Society.  The  commemoration  of  the  seventy-fifth  anni- 
versary, on  the  16th  of  February  last,  marked  an  epoch  which 
will  be  held  in  lasting  remembrance  by  all  who  participated 
in  the  exercises  of  that  brilliant  occasion. 

In  view  of  my  official  connection  with  that  event  and  present 
relations  with  the  Society,  it  becomes  my  duty  to  collate  and 


ESS  A  YS  AND  A  I)  I)  It  ESSES.  3 1 1 

record  in  houh'  ixinnanciit  form  tJic  more  iin|»r)rtanf  itififlf-ntH 
reliitiiifjj  tli<!r(!t()  and  Lfrowini;  out  of  lliat  ovont,  wliioli  Ijave 
made  the  present  tlic  tnost  proHjX'rons  and  inHlniftive  year  in 
the  history  of  this  Society. 

The  (iordial  and  fraternal  reHponso  of  i\\i\  eleven  senior 
medical  societies  in  this  country  to  the  invitation  to  unite 
with  us  in  giving  expression  to  our  praise  and  gratitude  in 
memory  of  the  noble  men  who  founded  the  Society  in  1819 
was  a  fitting  exhibition  of  that  fraternal  comity  and  good- 
will which  make  kindred  of  us  all. 

An  occasion  which  brings  together  such  kindred  spirits  in 
homage  to  a  common  pursuit,  ain'mated  by  the  inspiration  of 
a  beneficent  profession,  enlarges  the  scope  of  thought  and 
broadens  the  conception  of  reciprocal  duty.  It  lifts  men  out 
of  the  rut  of  ])rovinciaI  utility,  widens  the  field  of  active  use- 
fulness, and  gives  spirit  and  activity  to  the  hopes  of  a  future 
more  brilliant  than  the  past. 

If  not  before,  we  know  now,  that  this  Society,  now  in  the 
prime  of  mature  life,  has  attained  that  standing  which  places 
it  among  the  foremost  medical  societies  in  this  country.  It 
has  been  my  good-fortune,  on  many  occasions  during  the 
past  twenty-five  years,  to  meet  in  various  assemblages  the 
most  distinguished  men  of  our  profession  in  this  country  and 
many  abroad,  and  I  have  always  returned  home  with  the 
conviction  that  there  were  members  of  this  Society  quite  up 
to  the  highest  attainments  of  the  scientific  physician.  The 
more  I  have  seen  of  the  profession  in  general,  the  higher  has 
been  my  estimate  of  the  talent  at  home.  Such  is  the  state- 
ment of  one  who  wishes  to  utter  only  the  simple  and  unre- 
served truth  of  observation  and  conviction. 

During  the  present  year  thirty-five  members  have  been 
admitted  to  full  active  membership.  This  fact,  together 
with  the  largely  increased  average  attendance  (53)  at  the 
regular  meetings,  gives  impetus  to  the  progress  which  has 
marked  the  history  of  this  Society  since  1866.  During  the 
first  sessiou  of  this  year  the  average  attendance  was  42J,  the 


312  ESSA  YS  AND  ADDBESSES. 

higliest  number  at  any  one  meeting  being  86  and  tlie  smallest 
26.  During  the  present  sessiou  the  average  attendance  has 
been  73,  the  highest  number  at  any  one  meeting  105,  and 
the  smallest  48.  So  that  it  is  shown  that  the  attendance  has 
continuously  increased  during  the  year.  Our  distinguished 
historian,  Dr.  J.  M.  Toner,  has  collected  ninety-four  titles, 
to  which  a  few  others  might  be  added,  of  contributions  to 
medical  and  other  scientific  journals  by  members  of  the  pro- 
fession of  this  District  who  died  prior  to  1866,  which,  he  adds, 
"  make  a  very  creditable  exhibit  of  their  intelligence,  high 
culture,  industry,  skill,  and  powers  of  observation."  Those 
ninety-four  essays  were  the  contributions  of  thirty  men  ;  fifty- 
seven  were  by  seven  authors,  and  thirty-two  were  the  contri- 
butions of  four  army  and  two  navy  surgeons.  The  lack  of 
ambition,  at  least  so  far  as  it  might  relate  to  the  acquisition 
of  a  national  reputation,  seems  to  have  been  a  characteristic 
of  the  earlier  members  of  this  Society,  among  whom  were 
some  very  learned  men.  It  does  not  appear  that  any  one  of 
them  took  advantage  of  the  unusual  opportunities  for  the 
attainment  of  a  national  reputation  offered  by  a  residence  in 
a  city  to  which  came  annually  the  most  distinguished  states- 
men, jurists,  and  politicians  from  every  part  of  the  country, 
and  in  which  resided  the  men  holding  high  positions  in  the 
national  government,  and  the  foreign  embassies.  It  cannot 
be  asserted  that  the  reputation  of  any  one  of  those  learned 
and  accomplished  physicians  extended  beyond  the  limits  of 
the  '^  Ten  Miles  Square."  Many  circumstances  may  have 
induced  such  modesty  and  reticence — such  as  the  laborious 
life  of  medical  men  during  that  period;  the  competitive 
struggle  in  a  new  and  cosmopolitan  city,  with  limited  mail 
and  transportation  facilities;  their  interest  and  activity  in 
local  enterprises;  the  want  of  a  leader  with  courage  and  am- 
bition to  set  the  example  and  with  capacity  to  take  the  lead 
in  scientific  medical  litei^ature ;  the  limited  opportunities  in 
the  country  for  such  publication,  and  none  in  this  city — but 
the  most  rational  explanation  lies  in  the  fact  that  prior  to 


ESS  A  YS  A  NI)  ADD  II KSSKS.  3  ]  3 

1866  this  Society  only  irict  occasionally,  at  very  rornotf;  in- 
tervals, for  tli(!  (liHciiSHion  of  medieval  and  .scientific  8ubjef;ts. 
The  last  clause  in  the  j)rcce(ling  sentence  sounds  the  keynote 
of  progress  and  eminent  success  in  every  medical  community. 
A  practical  and  active  working  medical  society  is  the  final 
extension  of  the  collegiate  and  hospital  education.  The  later 
history  of  the  j)rofession  in  this  district  establishes  the  fact 
that,  with  hut  few  exceptions,  those  who  have  attained  the 
greatest  success  have  been  active  and  intelligent  workers  in 
this  Society. 

Since  the  date  (1866)  at  which  the  scientific  department 
was  reorganized,  the  number  and  value  of  such  contributions 
have  increased  beyond  the  possibility  of  any  statement,  suffi- 
ciently condensed  for  this  address,  that  would  intelligently 
and  adequately  set  forth  their  actual  and  relative  scientific 
value.  Suffice  it  to  say  that  many,  both  in  the  line  of  ex- 
haustive discussion  and  original  research,  have  been  of  the 
highest  merit  and  given  to  their  authors  world-wide  reputa- 
tions. Much,  however,  remains  to  be  accomplished.  The 
transactions  of  the  current  year  give  promise  of  a  progressive 
future  and  the  speedy  attainment  of  that  success  in  medical 
science  which  its  location  at  the  national  capital  demands. 

Time  does  not  permit  me  to  note  all  the  papers  (twenty- 
eight)  and  discussions  worthy  of  honorable  mention,  but  to 
omit  reference  to  some  of  more  than  ordinary  interest  would 
be  inexcusable  neglect  of  an  imperative  duty.  In  this  class 
I  include  the  paper,  with  discussion,  on  "  Diphtheria"  ;  the 
paper,  with  discussiou,  on  ^'  Typhoid  Fever"  ;  and  the  paper 
and  discussiou  on  '^  Appendicitis";  as  also  the  report  of  the 
special  committee,  with  the  discussion,  on  '■'■  Tuberculosis," 
and  the  report  on  the  water-supply  and  methods  of  filtration 
of  some  of  the  continental  cities.  This  special  notation  gives 
expression  with  marked  significance  to  the  ability,  industry, 
and  patient  research  of  those  to  whom  credit  is  due,  and  to 
the  value  of  the  information  added  to  the  common  store  of 
maiical  knowledge.     The  recent  papers  and  discussion  on 


314  ESSAYS  AND  ADDRESSES. 

"  Ear  Disease  "  are  worthy  of  the  highest  commendation.  I 
regret  that  the  report  of  the  special  committee  charged  with 
the  investigation  of  the  recent  introduction  of  smallpox  in 
this  city  could  not  be  submitted  during  the  present  session. 
The  symposium  on  tuberculosis  was  the  most  complete  pre- 
sentation of  recent  knowledge  of  the  subject  that  has  been 
made.  But  the  subject  which  has  attracted  the  most  wide- 
spread interest  and  attention  is  the  report  of  the  special  com- 
mittee on  the  causes  and  prevalence  of  typhoid  fever  in  the 
District  of  Columbia.  It  has  disseminated  more  generally 
the  reputation  of  this  Society  than  any  paper  or  report  ever 
read  before  it,  though  in  scientific  value  it  could  not  exceed 
the  elaborate  discussions  on  diphtheria  and  tuberculosis. 

For  the  first  time  in  the  history  of  this  great  government 
the  House  of  Representatives  of  the  Congress  of  the  United 
States  has,  through  one  of  its  standing  committees,  invited  a 
medical  society  to  appear,  through  a  committee  of  its  own 
members,  before  it  to  present  and  explaiu  the  report  of  its 
investigations  into  the  causes  and  prevalence  of  typhoid  fever 
in  this  District,  and  the  importance  and  necessity  for  an  in- 
creased and  improved  water-supply  and  sewerage-extension  ; 
and,  after  having  heard  that  committee,  ordered,  by  joint 
resolutions  of  both  Houses  of  Congress,  four  thousand  copies 
of  the  report  to  be  printed,  and  illuminated  with  the  graphic 
illustrations  which  your  committee  had  prepared  to  exhibit 
and  demonstrate  the  completeness  of  its  investigations.  Never 
before  in  the  history  of  this  Society  has  the  municipal  gov- 
ernment sought  its  advice  and  counsel  in  matters  of  grave 
importance  pertaining  to  sanitary  science,  and  given  promise 
of  cordial  co-operation  in  efforts  to  secure  the  enactment  of 
laws  to  regulate  the  practice  of  medicine  in  the  District  of 
Columbia,  to  secure  a  supply  of  pure  milk,  and  to  prevent 
the  desecration  of  graves.  And  not  until  recently  has  any 
body  of  its  citizens  requested  a  conference  with  a  committee 
of  this  Society  in  the  interest  of  the  reforms  referred  to, 
in  which   the  Board  of   Trade  is  equally  concerned  and  has 


KSSA  YS  A  Nl)  ADD  II ESSKS.  ;  J  |  o 

declared  ils  imrposc  In  ijiomotc.  Wliat,  is  tlic  Hi^j^iiifiranfe  of 
such  facts  as  I  have  thus  collated?  Do  they  not  emphasize 
the  ])ower  and  influence  of  this  Society  in  this  community, 
with  men  and  bodies  of  men,  and  with  tiu!  local  and  national 
governments;  and  invite  it  to  expand  its  usefnlnf-ss  in  a 
more  a^ojressivc  jjolicy,  in  the  line  of  additional  and  reform- 
atory logishition  promotive!  of  sanitation  and  prev(!nlive  medi- 
cine ?  I  appeal  to  you  to  accept  the  exhortation  I  have  so 
often  delivered  to  you — assert  yourself,  tiiat  you  may  widen 
the  sphere  of  your  usefulness  and  influence.  To  this  end  I 
offered,  at  the  semi-annual  meeting  in  July  last,  the  following 
amendments  to  the  Constitution,  which  I  commend  to  your 
favorable  consideration: 

1.  On  or  about  the  first  Monday  of  January,  annually, 
there  shall  be  appointed  by  the  President  a  Committee  on 
Public  Health,  to  consist  of  seven  active  members. 

It  shall  be  the  duty  of  said  Committee  on  Pnl)lic  Health 
to  report  annually,  in  January,  the  condition  of  the  public 
health  for  the  preceding  year. 

2.  On  or  about  the  first  Monday  of  January,  annually, 
there  shall  be  appointed  by  the  President  a  Committee  on 
Legislation,  to  be  comnosed  of  seven  active  members.  Said 
Committee  on  Legislation  shall  discharge  such  duties  pertain- 
ing to  legislation  as  the  Society  may  direct. 

These  two  propositions  are  of  sufficient  importance  to  com- 
mand your  attention.  The  third  introduces  a  debatable  issue, 
and  is  as  follows  : 

3.  On  or  about  the  first  Monday  of  January,  annually, 
there  shall  be  appointed  by  the  President  a  Committee  on  the 
Relation  of  the  Medical  Society  of  the  District  of  Columbia 
to  the  Public  Welfare,  to  consist  of  five  active  members. 

It  shall  be  the  duty  of  this  committee  to  con-^ider  the  pro- 
priety and  expediency  of  communications  to  the  public  either 
by  the  publication  of  reports  or  abstracts  of  the  proceedings 
of  the  Society,  and  of  the  admission  of  reporter  or  other 
persons  to  the  meetings  on  special  occasions. 


316  ESSAYS  AND  ADDRESSES. 

When  said  committee,  with  the  consent  of  the  Society,  shall 
determine  to  make  any  communication  to  the  public,  it  shall 
prepare  and  supervise  the  printing  and  publication  of  such 
communication. 

The  purpose  of  this  third  proposition  is  to  prescribe  some 
definite  method  of  communicating  with  the  public  at  large, 
when,  as  occasion  may  occur,  it  is  important  or  necessary 
that  the  general  public  should  be  advised  of  the  consideration 
of  matters  that  refer  to  the  well-being  and  healthf  ulness  of 
the  community,  and  in  which  there  is  such  general  interest 
as  makes  it  expedient  and  proper  to  present  the  consensus  of 
medical  opinion  to  the  consideration  of  the  community  at 
large.  Some  such  regulation  or  reform  is  a  very  desirable 
advance  in  the  method  of  this  Society.  It  will  bring  it  in 
closer  touch  with  public  sentiment  and  place  its  membership 
upon  the  highest  plane  of  good  citizenship.  The  meetings 
of  the  American  Medical  Association  and  of  its  sections,  of 
the  State  Medical  Societies,  of  the  Congress  of  American 
Physicians  and  Surgeons,  and  of  the  various  special  societies 
are  open  to  the  public  without  the  semblance  of  restraint 
upon  the  admission  of  the  general  public.  Why  should  this 
Society  deny  admission  to  laymen  to  a  discussion  on  the 
differential  diagnosis  of  chickenpox  and  smallpox,  or  on  the 
prevention  and  management  of  tuberculosis,  such  as  took 
place  during  the  present  year,  or  on  the  report  of  the  com- 
mittee on  the  causes  and  prevalence  of  typhoid  fever  in  the 
District  of  Columbia  ?  We  cannot  fill  the  measure  of  our 
responsibility,  and  acquire  the  power  and  influence  in  this 
community  that  belong  to  us,  if  this  Society  continues  to 
withhold  from  the  general  public  the  information  to  which 
every  good  citizen  is  entitled.  The  Sanitary  League  and 
the  Board  of  Trade  have  already  grasped  the  opportunities 
in  which  this  Society  should  have,  long  ago,  assumed  the 
leadership. 

When  I  came  here  (1848),  and  for  many  years  previous, 
there  was  a  coterie  of  medical  men  distinguished  for  their 


ESS  A  YS  AND  A  DDR  f'JSSES.  I]  ]  7 

professional  attainments  and  liononid  for  their  |iiil)lie  yitirit. 
Tliey  eame  to  th(!  front  in  (ivery  (interprisc!  to  protnotf;  the 
well-being  of  sooiety,  tli(!  eoniforts  of  life,  and  the  ha|)})inc88 
of  the  people  at  large.  Their  habits  of  life,  general  infor- 
mation, and  high  sense  of  pnblic  duty  not  only  fitted  them 
for  the  eommon  duties  of  good  citizenship,  but  impelh-d  them 
to  share  the  responsibilities  and  ol)ligations  in  all  measures 
pertaining  to  the  Commonwealth.  That  sueh  men  should 
command  a  dominant  influence  in  any  eommnnity  goes  with- 
out saying.  But  it  is  not  so  mucii  the  fact  tliat  such  was  the 
case,  as  it  is  the  example  that  should  be  of  most  value  to  their 
successors  and  survivors.  The  medical  profession  does  not 
entail  compulsory  exemption  from  the  ordinary  public  duties 
of  good  citizenship,  and  the  time  has  come  when  this  Society 
should  assert  itself  with  all  the  vigor,  force,  and  power  which 
such  a  body  of  men  united  in  a  common  cause  could  develop 
and  exercise. 

During  the  present  year  the  class  of  ''  membership  by  in- 
vitation "  has  been  increased  by  the  election  of  thirty-five 
men  coming  from  the  medical  corps  of  the  Army,  Navy, 
and  Marine-Hospital  Service,  the  three  chief  officers  of  these 
corps  being  included  in  the  number.  This  is  a  full  and  com- 
plete restoration  of  the  esprit  de  corps  and  comradeship  which 
subsisted  in  the  early  period  of  the  history  of  this  Society, 
but  had  practically  lapsed  for  many  years  past,  due,  perhaps, 
more  to  inadvertence  than  to  intention.  That  you  may  the 
more  fully  realize  the  importance  and  significance  of  this 
restoration,  let  me  recall  your  attention  to  the  active  and 
direct  participation  of  surgeons  in  the  Army  and  Navy  in  the 
foundation  and  organization  of  this  Society  and  of  the  Medical 
Association.  Thomas  Heudersou  and  Richard  \yeightman, 
of  the  Army,  and  Samuel  Horsley,  of  the  Navy,  were  present 
at  the  meeting  of  the  physicians  of  Washington  and  George- 
town, September  26,  1817,  called  to  consider  the  expediency 
of  the  ^'  organization  of  a  medical  society."  The  former  was 
one  of  seven  appointed,  at  that  meeting,  to  "  draft  a  consti- 


318  ESSAYS  AND  ADDRESSES. 

tution  and  by-laws,"  aud  at  the  first  meeting,  held  after  the 
adoption  of  the  report, Weightman  was  elected  Librarian  and 
Henderson  Recording  Secretary,  to  which  office  the  latter  was 
re-elected  at  the  first  meeting  (March  8,  1819),  held  after  its 
incorporation.  These  incidents  in  the  early  history  of  this 
Society  affirm  the  close  relation  and  active  co-operation  of  the 
two  military  corps,  through  their  distinguished  representa- 
tives, in  the  preliminary  organization  and  the  foundation  of  a 
medical  society  which  has  continuously  maintained  an  active 
existence  in  commemoration  of  the  wisdom  of  its  founders. 
In  1820  Edmund  Cutbush,  of  the  Navy,  and  in  1822  Joseph 
Lovell,  the  first  Surgeon-General  of  the  Army,  were  admitted 
to  membership  ;  and  throughout  the  entire  period  of  seventy- 
five  years  there  has  been  a  continuous  succession  of  member- 
ship of  Army  and  Navy  surgeons. 

Strange  as  it  may  seem,  it  is  nevertheless  true  that  Sur- 
geon-General Lovell  was  the  founder  of  the  Medical  Asso- 
ciation of  the  District  of  Columbia.  Thomas  Miller,  in  his 
inaugural  address,  delivered  upon  his  accession  to  the  presi- 
dency, states  distinctly  that  the  preliminary  movements  to 
effect  the  organization  were  suggested  by  General  Lovell, 
and  that  he  furnished  a  transcript  of  the  rules  and  regula- 
tions of  a  similar  society  in  Boston  fi)r  the  instruction  and 
guidance  of  those  associated  in  its  establishment.  Lovell 
aud  Henderson  were  members  of  the  committee  to  draft  "a. 
system  of  ethics  and  fee  bill."  Lovell  was  elected  one  of  the 
counsellors  at  the  first  meeting,  and  Henderson  was  the  author 
of  the  address  to  the  public  to  explain  the  objects  and  pur- 
poses of  the  organization,  and  quiet  the  discontent  and  ani- 
mosities which  had  incited  the  community  to  threaten  acts  of 
violence. 

The  active  influence  of  Lovell  and  Henderson  in  the 
organization  and  permanent  establishment  of  the  Medical 
Association  of  the  District  of  Columbia  seems  to  have  been 
entirely  forgotten.  It  was  formed  to  unite  the  profession 
into  one  concrete  body,  upon  the  basis  of  high  professional 


/';,S',SM  J'-V  AND  ADDIIKSSICS.  .",]'J 

character  and  deconitii,  iiiid  to  (■Ht5il)liHli  and  maintain  nni- 
formity  of  professional  relation  and  intereriurse  ljetu-e(!ti  its 
members,  thereby  .segn^guting  the  pretenders,  (;harlatanH,  and 
men  of  low  and  doubtful  repute,  and,  at  the  same  time,  pre- 
sent the  profession  to  the  eoniniunity  as  a  body  of  gentlemen, 
animated  by  the  highest  impulses  of  honor,  dignity,  and  the 
obligations  of  Christian  physicians.  The  wisdom  of  its 
organization  has  been  attested  by  its  history. 

The  interesting  and  pertinent  facts  arc  that  Army  and 
Navy  surgeons  were  a(;tively  instrumental  in  the  organization 
of  the  two  medical  societies  in  the  District,  one  of  which  ha.s 
completed  its  seventy-fifth  and  the  other  its  sixty-first  year  of 
continuous  existence,  and  that  the  profession  of  this  District 
owes  to  two  army  surgeons  the  inception,  organization,  and 
successful  defence  of  a  society,  established  in  1833,  to  define 
and  prescribe  the  rules  and  regulations  of  ethical  intercourse 
and  relations  of  medical  gentlemen,  and  of  the  profession  with 
the  public.  Such  historical  events  ought  to  guarantee  per- 
manency of  good-feeling  and  harmonious  co-operation  in  all 
the  relations  of  professional  life  and  association  between  the 
members  of  these  military  corps  on  duty  in  this  district  and 
the  profession,  with  so  many  of  whom  they  may  be  brought 
into  the  closest  professional  intercourse. 

And  now,  gentlemen  of  the  government  services,  in  view  of 
the  foregoing  citations  of  the  early  and  recent  incidents  of 
our  history,  I  offer  you  the  greetings  of  a  cordial  and  frater- 
nal friendship,  and  bid  you  welcome  to  the  home  of  your  sires. 

And  I  offer  you  the  congratulation  of  a  record  without  one 
negative  vote  on  the  admissions  of  thirty-five  men. 

The  attempted  but  unsuccessful  revolt  of  the  community 
against  the  Medical  Association  of  the  District  of  Columbia 
was  a  most  remarkable  occurrence.  It  was  a  strange  freak 
of  public  opinion  that  assembled  citizens  in  mass-meetings  to 
orjiauize  concerted  action  to  frustrate  the  united  efforts  of 
physicians  to  enforce  such  rules  of  conduct  as  would  secure 
to  the  community  the  full  fruition  of  the  highest  qualilica- 


320  ESSAYS  AND  ADDRESSES. 

tious  of  the  medical  fraternity  and  harmonious  co-operation 
among  themselves  in  a  common  pursuit.  And  it  was  even 
more  strange  that  the  same  citizens  should  in  mass-meeting, 
in  angry  misapprehension,  have  resolved  to  sever  the  close 
relation  of  the  family  physician,  and,  to  accomplish  this  pur- 
pose, have  invited  from  a  distance  an  influx  of  strangers  to 
supply  the  places  and  accept  the  confidences  of  the  evicted 
family  physicians.  It  was  not  less  remarkable  that  men  so 
lacking  in  esprit  de  corps  should  have  been  so  easily  found 
to  respond  to  such  momentary  outbursts  of  bad  temper  and 
bad  manners.  The  sturdy  independence  and  courage  of  such 
men  as  Lovell,  Henderson,  Thomas  Miller,  and  their  associ- 
ates were  in  marked  contrast  with  the  conduct  of  those  who 
took  fright  and  withdrew  from  the  Association  and  of  those 
who  refused  to  join  it  until  peace  had  been  restored.  Fortu- 
nately for  the  reputation  of  the  profession,  there  is  no  record 
of  the  names  of  such  recusants,  beyond  the  statement  of  Mil- 
ler to  the  effect  that  "  those  who  had  withdrawn  returned, 
and  those  who  settled  here  under  the  call  of  the  citizens  peti- 
tioned for  admission." 

The  Health  Department  of  this  District  should  command 
your  immediate  and  active  attention.  With  the  present 
management,  and  your  earnest  and  effective  co-operation 
with  the  Board  of  Commissioners  and  that  body  of  intel- 
ligent and  practical  business  men  known  as  the  Board  of 
Trade,  it  may  be  speedily  advanced  to  that  standard  of 
proficiency  in  sanitary  science  and  practical  work  that  will 
make  it — what  it  ought  to  have  been  long  ago — the  most 
progressive  and  complete  department  of  the  kind,  and  an 
example  to  all  others  in  this  country. 

There  should  be  established,  under  the  immediate  and 
direct  supervision  of  this  department,  a  biological  labora- 
tory, equipped  with  a  skilled  bacteriologist,  a  competent 
assistant,  and  janitor,  and  supplied  with  all  the  appurte- 
nances necessary  for  bacteriological  examination  of  water, 
soil,  dusts,  milk,  and  food,  and  also  to  determine  the  pres- 


ESSAYS  AND  A  hnilESSKS.  :>2\ 

ence  and  nature  of  specific  pathoj^enic  g(;rm3  in  cascH  of  suh- 
pected  contagious  and  infectious  disease. 

Just  now,  wlicn  the  medical  world  is  enlliused  with  the 
experiuK'ntal  suce&ss  of  antitoxin  in  the  pnsvention  and  treat- 
ment of  diphtheria,  this  capital  of  a  great,  rich,  and  powerful 
nation  is  without  the  means  and  applianr-es  neeessary  for  even 
an  experimental  observation.  The  good  or  had  efFeets  can- 
not even  be  seen,  much  less  tested  and  verified.  This  city 
should  be  the  centre  from  which  should  emanate  the  infor- 
mation relating  to  such  a  discovery,  and  from  which  should 
be  distributed  to  the  millions  throughout  the  land  a  remedy 
which  gives  promise  of  such  untold  beneficence  to  mankind, 
in  that  it  may  rob  that  most  dreadful  and  fatal  disease  of  its 
virulence  and  mortality. 

The  phenomenal  progress  and  discoveries  in  the  past  ten 
years  give  assuring  promise  of  the  coming  triumph  of  medi- 
cal science,  when,  with  the  consent  and  intelligent  co-opera- 
tion of  the  people,  it  will  establish  its  ability  to  eradicate  all 
preventable  diseases,  and  then,  and  then  only,  will  it  have 
accomplished  the  highest  aims  of  maximum  beneficence. 

Now,  permit  me  to  call  your  attention  to  some  of  the 
absurdities  of  the  laws,  regulations,  and  practices  relating  to 
the  health  and  Health  Department  of  this  District. 

The  chief  clerk  of  the  department  is  the  deputy  health 
officer — a  combination  of  two  systems  in  one  occupation.  If 
a  health  officer  can  only  be  qualified  by  a  medical  education, 
why  is  not  such  a  qualification  equally  necessary  for  his 
deputy  ? 

The  inspection  of  plumbing  is  under  the  Engineer  Depart- 
ment. Permits  to  do  the  work  should  remain  as  at  present. 
It  is  not  necessary  that  the  inspector  should  be  a  physician, 
but  he  should  be  a  thoroughly  qualified  officer  and  under  the 
immediate  direction  and  supervision  of  the  Health  Depai't- 
ment. 

The  supervision  of  foods  and  drugs  and  prosecutions  for 
adulterations  are  in  charge  of  the  Commissioner  of  Internal 

21 


322  ESSAYS  AND  ADDRESSES. 

Revenue,  a  bureau  of  the  United  States  Treasury  Depart- 
ment— a  glaring  absurdity,  fringed  with  red  tape. 

The  Health  Department  is  charged  with  the  work  of  kid- 
napping unlicensed  dogs  and  impounding  other  roving  beasts. 

The  disinfection  of  private  dwellings  in  which  contagious 
diseases  have  occurred  is  intrusted  to  dog-catchers  and  cattle- 
drivers  because  of  inadequate  force  and  no  money,  with  seven 
hundred  thousand  dollars  surplus  revenue  in  the  vaults  of 
the  Treasury  Department.  The  Pound  Service  ''  may  be 
more  honored  in  the  breach  than  the  observance,"  and  the 
master  and  his  whips  may  "be  gashed  with  honorable  scars," 
but  the  service  lies  too  low  in  the  lap  of  glory  to  command 
that  class  of  intelligent  employes  required  for  the  disinfection 
of  private  dwellings.  The  department  should,  without  re- 
gard to  cost,  be  supplied  with  the  necessary  apparatus,  appli- 
ances, vans,  and  employes  for  prompt  and  efficient  disinfec- 
tion of  dwelling,  furniture,  and  clothing. 

The  medical  relief  of  the  poor,  supervision  of  admission  of 
the  poor  to  hospitals,  location  and  direction  of  free  dispensa- 
ries, and  control  of  physicians  to  the  poor  are  distributed 
around  and  about  to  a  variety  of  supervisions.  They  should 
be  under  one  director,  preferably  the  Health  Department. 

Deaths  without  medical  attendance,  suspicious  and  crim- 
inal deaths  may  or  may  not,  according  to  circumstances,  be 
referred  for  investigation  to  either  the  health  officer  or  cor- 
oner, or  both.  Uniformity  of  procedure  and  certainty  of 
result  require  that  one  of  these  officers  should  have  the 
exclusive  supervision  of  all  such  classes  of  deaths. 

The  jurisdiction  of  the  health  officer  over  the  management 
of  the  public  schools  is  limited  to  the  abatement  of  nuisances 
in  or  about  the  buildings,  vaccination  of  the  scholars,  and  dis- 
infection of  buildings  during  prevalence  of  contagious  dis- 
eases. Is  it  not  as  much  the  duty  of  the  Commonwealth  or 
municipality  to  make  vigorous  and  healthy  mothers  and 
fathers  as  it  is  to  make  scholars  ? 

The  power,  prosperity,  wealth,  and  progress  of  a  nation 


ESSAYS  AN/)  An  DRESSES.  323 

consist,  for  tlu;  most.  |);irt,  in  the  miiulK'r,  licuitli,  vigor, 
and  intelligence  of  its  |)oi)ulation.  iSlioiiUl  not  then  the 
health  otFuter,  or  some  other  e(|ually  eomiuitcnt  offir/'r,  Ik? 
charged  with  some  definite  supervision  (;f  the  j)]ans  and  con- 
structitm  of  the  sehool-hnildings,  and  of  the  curriculum,  that 
the  physical  Ixiing  may  not  be  sacrificed  and  dwarfed,  eithfr 
by  the  absence  of  or  improper  physical  culture,  or  too  miurh 
and  too  high  mental  development? 

As  an  additional  illustration  of  the  unwise  and  phenomenal 
legislation  of  Congress,  I  will  cite  the  following  : 

The  joint  resolution  legalizing  the  health  ordinances  and 
regulations  enacted  by  the  Board  of  Health  before  its  aboli- 
tion, excepts,  l)y  special  designation,  from  such  legalization 
sections  7,  9,  and  14  of  the  ordinance  *'  to  declare  what  shall 
be  deemed  nuisances  injurious  to  health,  and  to  provide  for 
the  removal  thereof ;"  consequently  those  sections  are  inoper- 
ative and  void. 

Section  7  refers  to  the  abatement  of  nuisances  arising  from 
stagnant  water  and  marshy  lauds  made  ''  by  defective  drain- 
age or  otherwise." 

Section  9  refers  to  the  abatement  of  nuisances  of  ''  filthy 
and  offensive"  dwelling-houses  or  buildings  "  wherein  people 
live,  congregate,  or  assemble." 

Section  14  limits  the  duties  of  scavengers  to  the  officers 
appointed  for  that  purpose. 

The  repeal  of  these  provisions  of  the  ordinance  not  only 
strips  the  Health  Department  of  all  powers  to  abate  the  nuis- 
ances referred  to  in  sections  7  and  9,  which  are  so  common 
and  detrimental  to  health  ;  but,  by  the  repeal  of  section  14, 
seeks  the  promotion  and  continuous  increase  of  defective, 
leaking,  and  unclean  privies,  by  inviting  every  householder 
to  be  his  own  scavenger. 

With  nine  thousand  privies  in  the  city  of  Washington, 
there  may  be,  by  authority  of  Congress,  an  equal  number  of 
night-soil  scavengers,  with  as  many  volunteer  assistants,  not 
one  of  whom  would   be  amenable  to  anv  lec^al  or  sanitary 


324  ESSAYS  AND  ADBBESSES. 

regulation.  Such  are  examples  of  the  intelligent  legislation 
for  this  District  by  the  Congress  of  the  United  States. 

And  now,  coming  nearer  to  our  fiduciary  policies,  look  at 
the  discrimination  between  the  two  professions.  The  attorney 
and  his  two  assistants  receive,  respectively,  four,  two,  and 
one  thousand  six  hundred  dollars  per  annum.  The  health 
officer,  medical  sanitary  inspector,  and  chemist  inspector  of 
dairy-products  receive,  respectively,  three  thousand,  fifteen 
hundred,  and  twelve  hundred  dollars  per  annum.  But  this 
is  not  all.  The  chemist  of  asphalt,  cement,  street,  and  sewer 
material  receives  two  thousand  and  four  hundred  dollars  per 
auuum,  while  the  chemist  of  dairy-products,  the  food  of 
babies,  children,  and  to  a  greater  or  less  extent  of  the  entire 
population,  gets  but  twelve  hundred  dollars  per  annum — not 
much  more  than  enough  to  supply  a  baker's  family  with  an 
abundance  of  pure,  fresh  milk. 

All  these  and  many  more  of  such  incongruities  of  law, 
regulations,  and  practices  are  in  vogue  in  the  capital  city  of 
this  great  nation. 

The  study  of  the  morbid  specimens  exhibited  at  the  weekly 
meetings,  an  average  of  2J  each  week,  many  of  which  were 
of  great  interest,  has  been  too  superficial  for  such  a  Society 
as  this.  As  a  rule,  the  members  are  content  with  an  objec- 
tive inspection  and  a  description  in  outline  of  the  case  by  the 
members  m  charge.  I  have  attempted  to  elicit  discussion, 
and  occasionally  indicated  the  points  of  special  interest,  hoping 
thereby  to  suggest  a  line  of  profitable  debate,  but  without  suc- 
cess. Such  specimens  offer  the  opportunity  for  the  practical 
study  of  the  nature  and  diagnosis  of  disease,  and  consti- 
tute the  basis  and  groundwork  of  clinical  medicine.  With- 
out such  knowledge  the  practice  of  medicine  must  be  experi- 
mental and  empirical. 

The  exhibition  of  living  illustrations  of  rare  and  special 
cases  of  disease  should  be  encouraged.  It  will  add  greatly 
to  the  interest  and  instruction  of  our  deliberations. 

There  is  a  prevalent  misapprehension  among  the  younger 


ENHA  YS  A NI)  A  T) DRESSES.  :}25 

members  in  re.spo(!t  to  their  roliuitance  to  engage  in  the  dis- 
cussions of  scientific  subjects  because  of  the  fear  of  criticism. 
There  is  no  period  of  jirohatioii  or  parliamentary  eiiHtorn  in 
this  So(!iely  tiiat  imposes  any  restraint  upon  inteilcetiial  ca- 
pacity and  scientific  attainment.  He  who  knows  what  he  has 
to  say  can  and  ouf!;ht  to  say  it.  The  youngest  member  owes 
that  mncli  to  himself  and  to  his  seniors.  May  I,  in  this 
connection,  tell  you  that  the  first  paper  I  read  before  a  medi- 
cal society,  now  forty-two  years  ago,  was  criticised  with 
unflinching  severity  by  the  late  Dr.  Wotherspoon,  of  the 
Army.  I  was  like  the  poor  boy  at  a  country  frolic,  but  I 
did  not  hide  behind  the  barn-door  and  peep  through  the 
cracks  to  see  who  was  in  pursuit,  but  stormed  the  battery, 
coming  out  of  it  badly  damaged,  but  alive,  and  have  been 
myself  ever  since.  May  one,  who  was  a  doctor  Ijefore  the 
parents  of  many  of  you  were  married,  and  who  has  passed 
through  the  crucible  of  criticism,  invite  and  lead  you  to  the 
front  rank  of  active  and  aggressive  membership,  for  which  so 
many  of  you  are  so  well  fitted  ? 

Some  method  should  be  devised  to  economize  the  time  of 
the  weekly  meetings.  The  elaborate  reports  prepared  by  the 
very  efficient  Recording  Secretary  consume  a  period  of  time 
varying  from  twenty  to  forty  minutes,  which  should  be  de- 
voted to  the  scientific  transactions.  I  have  given  this  matter 
much  consideration  and  recommend  to  you  the  creation  of 
the  office  of  Assistant  Recording  Secretary,  with  a  moderate 
salary,  the  incumbent  of  which  office  shall  be  charged  with 
the  duty  of  making,  after  consultation  with  the  members  con- 
cerned, the  necessary  corrections  in  the  reports,  which  shall 
be  verified  by  a  committee  consisting  of  the  President,  Re- 
cording and  Assistant  Secretaries,  and  when  any  alteration  is 
made,  not  accepted  by  said  committee,  such  fact  shall  be  re- 
ported to  the  Society  at  the  meeting  succeeding  that  at  which 
the  discussion  took  place. 

The  policy  and  propriety  of  inviting,  during  each  year, 
one  or  more  men  from  other  cities,  of  eminent  distinction  in 


326  ESSAYS  AND  ADDRESSES. 

special  branches  of  medical  science,  to  deliver  addresses  before 
you,  are  worthy  of  your  consideration.  Care  should  be  taken 
to  av^oid  the  role  of  the  advertising  medium,  and  restrict  such 
invitations  only  to  physicians  whose  eminent  success  and  high 
character  preclude  even  the  suspicion  of  motives  of  doubtful 
repute.  If  in  your  judgment  such  a  departure  from  the  or- 
dinary routine  of  society  proceedings  should  be  established, 
put  it  upon  the  highest  plane  of  intellectual  capacity,  eminent 
success,  and  highest  personal  integrity,  and  then,  and  then 
only,  will  the  distinguished  honor  find  its  compensation  in 
the  recompense  of  a  duty  well  done. 

I,  in  common  with  many  members,  regret — in  fact,  I  hope 
the  regret  is  shared  by  every  member — that  the  recommenda- 
tions of  my  immediate  predecessor,  in  regard  to  the  acquisition 
of  a  permanent  home,  could  not  be  realized  because  of  the 
legal  disability  of  the  Society  to  borrow  or  raise  by  assess- 
ment the  necessary  amount  of  money  ;  but  it  can  receive  money 
by  gift,  donation,  and  bequest  to  any  amount  that  will  yield 
an  annual  income  not  exceeding  six  thousand  dollars.  Then 
why  not  proceed  as  best  we  can  to  commemorate  the  concluding 
session  of  the  seventy-sixth  year  by  liberal  donations  to  a 
home  fund?  Let  us  make  one  "  more  pull,  a  long  pull,  and 
a  pull  altogether,"  and  to  this  end  I  offer  you  the  opportu- 
nity, by  distributing  a  circular  subscription,  to  which  you 
may  affix  your  signatures,  with  the  amount  you  may  be  will- 
ing to  donate  annually  to  that  fund. 

The  Directory  for  Nurses,  for  the  most  part,  if  not  wholly, 
owes  its  organization  and  permanent  establishment  in  this 
city  to  this  Society.  It  has  now  become  self-supporting,  and 
is  provided  with  ample  accommodations  for  the  complete 
fulfilment  of  all  the  requirements  of  such  an  institution ;  but 
it  lacks  that  general  support  of  the  profession  of  the  District 
to  which  it  is  entitled,  and  to  which  it  must  appeal  for  that 
continued  success  and  usefulness  which  have  contributed  so 
much  to  the  improved  management  and  treatment  of  disease. 
It  has  become  a  common  practice  for  competent  and  popular 


ESS  A.  YS  AND  ADD  II KHSES.  \W 

nurses,  after  liiivinj^  qualified  hy  registry  and  indorsement, 
and  aecjuinid  H])C(;iiil  popularity  with  rnetuhrrs  of  the  jirofes- 
sion,  to  witlidraw  fi-oin  the;  directory  and  organize  into  Hfpa- 
rate  directories  of  limited  members,  with  definite  headquar- 
ters at  Hele(!te(l  localities,  and  thcin,  by  special  and  persftnal 
solicitations,  obtain  preference  in  selection  over  those  to  whom 
employment  should  be  given.  The  members  of  this  Society 
owe  it  to  themselves  to  foster  this  institution  to  the  exclusion 
of  all  private  directories  or  association  of  nurses.  I  know 
this  reconaraendation  will  invoke  the  criticism  of  some  of  the 
best  and  most  popular  nurses  in  this  city  ;  but  my  duty  to  the 
sick  in  this  community  is  far  above  my  interest  in  the  success 
of  any  nurse  or  coterie  of  nurses. 

With  the  induction  of  my  successor  into  office  I  will  have 
performed  ray  last  official  act  and  completed  the  final  duty 
of  this  last  and  most  distinguished  honor  of  my  professional 
life.  In  the  coming  years  of  retirement  from  the  places  of 
honor  and  trust  in  tliis  Society  I  solicit  the  consideration  of 
one  who  will  not  be  in  the  way  of  preferment  and  success  of 
any  member,  and  will  value  the  regard  of  his  associates  and 
peers  as  the  measure  of  his  usefulness  and  success.  In  view 
of  these  considerations,  I  venture  to  incur  the  risk  of  unfav- 
orable criticism  by  making  the  following  recommendation: 
Experience  and  observation  have  convinced  me  that  annual 
rotation  in  the  office  of  president  retards  the  progress  of  scien- 
tific societies,  more  especially  so  of  those  that  meet  at  short 
intervals  during  the  greater  part  of  each  year. 

Charles  Worthiugton,  the  first  President,  was  re-elected 
for  twelve  successive  years ;  Thomas  Sims  died  during  his 
third  term;  Frederick  May  occupied  the  office  during  fifteen 
successive  years ;  James  C.  Hall  declined  a  re-election  at 
the  expiration  of  his  second  term  ;  Alexander  Me^Villiams 
died  before  the  expiration  of  his  first  year  ;  AYilliam  Jones 
was  honored  by  seven  re-elections;  Joseph  Borrows  by  six; 
Charles  H.  Liebermau  by  three  terms ;  and  Thomas  Miller 
by  two  ;  and  then,  1870,  began  the  routine  of  annual  rotation. 


328  ESSAYS  AND  ADDRESSES. 

During  fifty-three  years  but  nine  members  held  the  office  of 
president,  three  of  whom  died  in  office. 

I  do  not  advise  a  return  to  the  early  practice  of  re-election 
duriug  life,  but  I  do  advise  abandonment  of  the  annual  rota- 
tion, and  the  adoption  of  some  rule  of  action  that  will  more 
clearly  set  forth  the  importance  and  dignity  of  the  office  of 
'  president. 

Not  one  in  five  of  the  members  can,  to-day,  name  in  rota- 
tion the  ex-presidents  now  living,  and  it  is  even  doubtful  if 
each  one  of  them  can  name  the  year  of  his  service.  Such  are 
the  inevitable  results  of  the  lamentable  fact  that  no  one,  dur- 
ing the  past  twenty-four  years,  has  remained  in  office  long 
enough  to  impress  either  you  or  himself  with  the  dignity  and 
honor  of  an  office  that  rotates  the  incumbent  into  private  life 
annually  on  the  first  Monday  of  January.  Among  my  prede- 
cessors there  have  been  many  who  honored  themselves  by 
prompt  and  faithful  discharge  of  the  duties,  but,  like  others. 
they  stepped  down  and  out  at  the  expiration  of  one  year  of 
service.  The  record  honors  the  man  who  could  not  find  time 
to  come  once  a  week  to  these  weekly  meetings  as  it  does  the 
man  who  came  promptly  and  sat  here  throughout  the  hours, 
giving  his  undivided  attention  to  the  duties  imposed  upon 
him.  Do  not  justice  and  science  demand  discrimination 
between  the  unremitting  discharge  of  honorable  duties  and 
loose  and  slipshod  neglect  and  evasion  ?  My  suggestion, 
then,  is,  when  your  president  honors  himself  by  faithful, 
efficient,  and  satisfactory  services,  honor  yourself  by  a  re- 
election; and  then  mark  the  continuous  progress  of  this 
Society. 

But  one  death  has  occurred  in  the  membership  during  the 
year.  Dr.  Charles  J.  Osmun  died  of  diphtheria,  contracted 
in  the  line  of  duty,  thus  adding  another  to  the  numerous  in- 
stances of  personal  sacrifice  and  death  incurred  by  dangerous 
exposure  in  the  faithful  and  conscientious  discharge  of  the 
obligations  of  our  profession.  The  death  of  Osmun  and  of 
John  W.    Dunn,   of    the   same  disease,   contracted  in    like 


/';,V,S'y1  )',V  /I  A7>»  AI)l)lil-:SSES.  329 

inaiincr,  slioiild  ndmonisli  lis  of  the  necessity  of  rij^id  ;in<l 
thoroii<^li  iK'iSonal  liy^iciu!  during  attfiidaiirc  upon  such  rases, 
and  t(';u;h  Ihu  (;()imimiiity  th(;  iiialif^iiaucy  of  a  disease  from 
whi^ih  vvc,  with  all  possible  care,  cannot  acquire  exemption. 

And  now,  dis(;lainiln<;  any  invldioiisness,  I  must  commend 
to  your  consideration  the  distin^^-uisiicd  services  of  your  Chair- 
man of  the  Committee  on  Essays,  Dr.  Thomas  C.  Smith,  to 
whose  judicious  and  indefatii^able  labors  I  owe  the  debt  of 
profound  gratitude,  in  tliat  he  has  crowned  my  administration 
of  the  duties  of  presiding  officer  with  such  success. 

The  Treasurer  is  always  in  his  seat  guarding  the  treasury 
with  the  fidelity  of  one  who  insists  upon  holding  a  surplus 
and  adding  to  the  accumulations  of  the  Society. 

And,  finally,  I  beg  you  will  accept  my  thanks  for  the  honor 
couferred  by  election  to  a  sec(md  terra  to  this  high  office,  and 
for  the  uniform  courtesy  and  deference  shown  to  me  in  the 
discharge  of  its  duties. 


THE  SOUTHERN  SURGICAL  AND   GYNECO- 
LOGICAL SOCIETY. 

address  of  welcome  to  the  southern  surgical  and 
gynecological  society,  delivered  at  wash- 
ington, november  12,  1895. 

Mr.  President  and  Members  of  the  Southern  Sur- 
gical AND  Gynecological  Association  :  Through  the 
partiality  of  the  distinguished  Chairman  of  your  Committee 
of  Arrangements,  I  am  here  to  offer  the  fraternal  greetings 
of  the  medical  profession  of  the  District  of  Columbia  to  you 
at  this  first  meeting  of  your  Association  north  of  the  river 
Potomac.  This  invasion  is  the  expression  of  that  friendship 
and  comity  which  make  kindred  of  us  all,  and  is  significant 
only  in  that  it  is  a  voluutary  reunion  upon  common  territory 


330  ESSA  YS  AND  ADDRESSES. 

of  the  citizens  of  a  common  country,  Avho  are  engaged  in  a 
common  pursuit,  characterized  by  the  spirit  of  Christian 
benevolence  and  philanthropy. 

In  one  aspect  we  are  your  guests,  invited,  by  your  presence 
here,  to  participate  in  the  consideration  of  the  subjects  set 
forth  in  the  programme,  and  to  co-operate  with  you  in  pro- 
moting the  advancement  of  a  science  which  has  for  its  highest 
aims  the  amelioration  of  suffering  and  the  saving  and  prolon- 
gation of  human  life. 

I  need  not  then  tell  you  of  the  pleasure  it  gives  me  to 
bid  you  welcome  to  this  city  of  the  nation,  which  I  have 
seen  grow  from  its  village  appointments  to  the  proportions 
and  grandeur  of  the  nation's  metropolis ;  but  I  must  give 
expression  to  the  cordiality  and  fraternity  which  my  juniors 
in  the  practice  of  medicine  in  this  city  have  bidden  me  to 
offer  you  on  this  their  first  and  only  opportunity  to  congratu- 
late this  Association  on  its  success  and  achievements  in  the 
recent  past. 

The  population  of  this  city  is  largely  cosmopolitan,  and 
more  closely  representative  of  the  population  of  the  country 
at  large  than  that  of  any  other  city,  and  those  of  you  who 
come  from  the  tropical  regions  of  the  South,  as  well  as  those 
from  the  border  States  along  the  course  of  the  historical  line 
of  Mason  and  Dixon,  will  find  here  the  representative  types 
of  congenial  manhood  and  responsive  hospitality  from  every 
section  of  the  national  domain,  mingling  and  commingling 
in  one  homogeneous  community,  irrespective  of  local  and  State 
nativities  and  provincial  customs  and  characteristics,  and 
engaged  on  equal  terms  in  all  the  relations  and  pursuits  of 
business,  employment,  and  social  life.  There  are,  of  course, 
cliques,  coteries,  clans,  social  circles,  exclusive  factions,  gangs 
and  cabals  of  good  and  evil  import,  but  not  banded  by  State 
and  local  affinities.  But  the  truth  of  history  compels  me  to 
add  that  its  representative  character  would  be  incomplete 
without  such  slums  as  Swampoodle,  Murder  Bay,  Hell's 
Bottom,  and  Hooker's  Division — localities  where  vice  and 


KSSA  YS  AND  ADDRESSES.  .'j.'il 

crime,  in  ull  tlieir  loathsome  hideoufiness,  founfl  doraicilf  mikI 
protection,  but  wliich  are  now  rai)idly  dlHappearinj;  before 
the  onerj^y,  thrift,  and  ]>rot;rcs8  of  a  co.smopolit'xn  and  law- 
abiding  population. 

In  a  population  of  two  hundred  and  seventy  thousand  there 
are  one  hundred  and  (!i<^hty  (ihurches  ;  one  hundred  ar)d  three 
public  school  buildings,  with  an  attendance  of  forty-four  thou- 
sand pupils;  four  universities  in  suc(;C'Ssful  operation,  two 
more  in  course  of  CHtablishmcnt,  and  another  in  conteiujda- 
tiou;  five  medical  and  four  law  schools,  with  annually  increas- 
ing numbers  of  matriculates ;  five  general  and  two  special 
hospitals,  with  accommodation  for  seven  hundred  patients; 
two  foundling  hospitals,  one  emergency  hospital,  and  one  for 
incurables,  several  public  dispensaries,  one  deaf  and  dumb 
asylum,  and  one  insane  asylum.  There  are  seventy  well- 
established  charitable  and  reformatory  institutions,  providing 
for  the  care  of  the  indigent,  helpless,  sick,  injured,  and  way- 
ward, of  which  thirty-five  do  not  receive  any  public  aid,  but 
have  been  founded  and  are  supported  by  the  munificence  of 
philanthropic  citizens  and  residents  of  the  Federal  territory. 
There  is  not  one  gambling-house  ''  known  to  the  authori- 
ties," but  there  are  five  hundred  and  eighty  licensed  saloons 
— far  too  many  in  a  population  so  abundantly  supplied  with 
eleemosynary,  religious,  and  educational  institutions,  which 
in  some  measure  is  due  to  inadequate  legislation  by  Congress. 
Thus,  notwithstanding  our  dependence  upon  a  legislature 
without  representation,  the  citizens  and  private  property- 
holders  of  the  Federal  territory  exhibit  most  remarkable 
and  creditable  progress  in  all  those  qualities  and  instrumen- 
talities of  enlightened  and  Christian  civilization  which  con- 
tribute so  much  to  the  well-being  of  the  human  race  and  have 
made  this  the  foremost  nation  on  the  globe. 

You  must  excuse  the  interpolation,  in  this  connection,  of 
the  statement  that  in  this  District  the  death-rate  has  gradually 
diminished  in  the  past  fifteen  years,  and  the  average  longevity 
of  decedents  has  increased.     Amono;  the  whites  four  vears 


332  ESSAYS  AND  ADDBESSES. 

nine  mouths  and  nineteen  days,  having  risen  from  thirty-two 
years  and  three  days  in  1881  to  thirty-six  years  nine  months 
and  nineteen  days  in  1895;  and  among  the  colored  from 
twenty  years  ten  months  aud  eleven  days  in  1881  to  tweuty- 
five  years  eight  months  and  twenty-seven  days  in  1895. 
These  figures  exemplify  the  maxim  of  Professor  Pierce,  that 
'Wirtue,  like  intellect,  doubtless  tends  to  longevity."  If 
time  permitted,  I  might,  with  equal  precision,  show  that  this 
population  is  characterized  by  three  elements  of  strength  of  a 
people — "  longevity,  fecundity,  and  vigor." 

In  another  aspect  you  are  guests,  and,  in  behalf  of  the  pro- 
fession and  of  the  community  at  large,  I  welcome  you  to  the 
only  city  in  this  great  and  populous  country  wherein  each 
one  of  you  can  claim  and  enjoy  the  privileges  and  immunities 
vested  in  common  citizenship,  insomuch  as  each  one  and  all 
of  you,  in  some  measure,  hold,  in  common  with  the  many 
millions  of  citizens,  proprietary  rights  and  sovereign  power. 
That  you  may  fully  estimate  and  appreciate  the  magnitude  of 
such  prerogatives,  let  me  tell  you  that  in  the  area  of  69,245 
square  miles  covering  the  territory  of  the  District  of  Colum- 
bia the  Government  owns  four  thousand  two  hundred  and 
twenty  acres  of  land,  exclusive  of  the  streets,  avenues,  and 
alleys  of  the  city,  and  property  in  this  city  valued  at  $201,- 
711,959,  being  $10,294,155  in  excess  of  the  value  of  private 
property.  To  this  valuation  must  be  added  the  value  of  the 
Government  lauds  lying  outside  of  the  limits  of  the  city, 
which  comprise  three  thousand  four  hundred  and  twenty 
acres,  which,  with  the  improvements  thereon,  are  estimated 
at  the  low  valuation  of  eight  and  one-half  millions  of  dollars. 
The  aggregate  of  the  Government  realty  in  the  District  of 
Columbia,  including  the  streets,  avenues,  and  alleys  of  the 
city,  but  not  including  the  enormous  tract  of  reclaimed  Poto- 
mac River  flats  or  purchases  since  1889,  is  seven  thousand 
eight  hundred  and  twenty-six  acres  of  land. 

And  now,  if  you  will  go  with  me  through  these  streets  and 
avenues,  you  will  see  these  properties  represented  in  magnifi- 


ESSAYS  AND  ADDRESSES.  3.'i3 

cent  j)iil)li(;  biiildin^H,  docoratod  and  iuiprovod  parks  and 
rc'Hcrvations.  IJiit  tliin  \ryr;\\,  ({((vcrnincnf,  liaH  not  liinitfd  its 
possessions  and  csxix-nditiircs  in  (Ids  Distri'l  tf)  tlie  affjnisition 
of  realty,  the  construction  of  pul)li(;  buildings  and  improve- 
ment of  parks,  hut  has  been  a  generous  though  inaderpiate 
contributor  to  the  development  and  advanriement  of  various 
branches  of  science,  in  the  establishment  and  support  of 
bureaus  and  departments  of  science,  art,  and  literature,  com- 
prising Architecture,  Astronomy,  Astro-physics,  Animal  In- 
dustry, including  infectious  diseases  and  pathology  of  animals, 
dairy  investigations,  and  zoological  and  biochcmic  laboratories; 
Agrostology,  Biology,  Botany,  Bibliography,  ClimatoloLn-, 
Forestry,  Education,  Entomology,  Ethnology,  Hydro- 
graphy, Hydrometry,  Plygieue,  Ichthyology,  International 
Exchanges,  Meteorology,  Mammalogy,  Metallurgy,  Muscimi, 
Law,  Medicine,  Printing  and  Engraving,  Ornithology,  Ord- 
nance, Vegetable  Pathology  and  Physiology,  Pomology,  Soils 
and  Foods,  Weights  and  Measures,  Quarantine,  Bacteriology, 
Pathology,  Statistics,  and  Zoology. 

I  cannot  detain  you  with  a  statement  in  detail  of  the  opera- 
tions of  these  scientific  foundations,  not  as  yet  complete  in  any 
department,  but  steadily  progressing  toward  that  standard  of 
excellence  and  usefulness  which  will,  in  the  near  future,  make 
the  political  home  of  the  nation  the  centre  of  science,  litera- 
ture, and  art.  But  I  can  assert  that  in  learned  and  scientific 
institutions,  bureaus,  departments,  and  great  national  libra- 
ries, with  their  corps  of  experts  in  the  various  branches  of 
science,  this  city  offers  opportunities  not  excelled  in  any  city 
in  this  country. 

And  now,  coming  closer  to  that  branch  of  science  which 
most  concerns  you,  I  must  remind  you  that  the  same  spirit 
which  has  given  impetus  to  new  thought  and  to  new  and  en- 
larged conceptions  of  scientific  research  has  established  in  this 
city  a  medical  library  greater  in  number  and  value  of  volumes 
than  any  similar  library  in  the  world,  and  an  anatomical  and 
pathological  museum  unsurpassed  in  the  variety  of  its  collec- 


334  ESSA  YS  AND  ADDRESSES. 

tions.  The  publication  of  the  Index  Catalogue  iu  connection 
with  this  magnificent  library  will  contribute  more  toward  the 
higher  education  of  the  medical  profession  than  any  single  act 
of  any  nation  on  the  face  of  the  globe.  Then,  too,  the  Gov- 
ernment has  established  a  Museum  of  Hygiene  and  a  National 
Quarantine,  both  important  adjuncts  of  preventive  medicine, 
which  will  continue  to  grow  in  usefulness  to  the  Government 
and  to  the  people-at-large. 

These  foundations  have  been  developed  under  the  fostering 
care  of  a  munificent  Government.  It  may  be  that  it  needed 
these  establishments  to  fulfil  its  delegated  functions,  and  is 
compelled  to  secure  the  services  of  skilled  medical  men  (to 
superintend  their  proper  administration) ;  nevertheless,  even 
admitting  this  necessity  to  be  the  primary  cause  for  their  foun- 
dation, it  in  no  manner  impairs  their  value  to  the  profession, 
and  the  duty  is  imposed  upon  us  to  utilize  them  for  the  com- 
mon good  and  to  widen  the  scope  of  such  endowments  to  the 
end  that  we  and  the  people  may  realize  the  full  measure  of 
their  usefulness. 

I  solicit  your  aid  and  co-operation  in  our  effort  to  secure 
the  protection  of  our  people  from  the  horde  of  impostors  and 
charlatans  which  you  have  driven  from  your  borders  by  the 
enactment  and  enforcement  of  medical  practice  laws,  and 
which  has  made  the  District  of  Columbia  a  common  rendez- 
vous where  the  most  atrocious  methods  of  the  charlatan  and 
mercenary  impositions  are  openly  and  flagrantly  committed 
to  the  wrong,  injury,  and  robbery  of  its  citizens.  You  repre- 
sent the  most  influential  and  intelligent  class  of  suffragists, 
for  whose  aid  on  the  hustings  and  at  the  polls  we  plead. 

To  state  the  deplorable  condition  of  this  District  fully  and 
broadly,  there  are  five  medical  schools  and  several  medical 
societies  chartered  by  Acts  of  Congress,  or  under  the  general 
incorporation  law,  authorized  and  empowered  to  license  per- 
sons to  practise  the  art  and  science  of  medicine,  without  any 
uniform,  and  by  some  without  any  standard  of  qualification 
beyond  the  ability  and  willingness  of  the  applicant  to  pay  the 


E8SA  YS  AND  ADD  [I  ICSSES.  ?,:\r) 

required  fee.s  or  f;iv(!  |)r()iiiiHS()ry  noloH  for  hik-Ii  paynifiit; 
and  under  ilie  proviHions  of  tlic;  ji;<'iifi;tl  inrorporation  law 
any  dozen  of  pcrHona  eun  obtain  a  eiiarter,  ujjon  payment  of 
the  fee  for  reeordinjr  the  same,  authori/infr  them  as  a  brxly 
corporate  to  confer  the  degree  of  M.  D.  at  their  pleasure  and 
will.  kSuch  is  the  status  of  this  Federal  tc-rritory,  which  is 
under  the  exclusive  jurisdiction  of  the  highfst  tribunal  of 
legislation  in  the  land,  made  up  of  the  Representativfjs  and 
Senators,  from  forty-one  States  and  Territories,  which  have 
enacted  medical  practice  laws  for  the  protection  and  welfare 
of  their  citizens.  Take  these  facts  home  with  you  and  re-echo 
them  throughout  the  length  and  breadth  of  the  land,  that 
such  briminal  neglect,  not  less  disgraceful  and  scandalous  than 
the  slums  of  vice,  may  not  continue  to  afflict  the  citizens  of 
the  Federal  territory. 

Pardon,  in  conclusion,  the  invocation  of  one  who  has  nearly 
completed  a  half-century  of  service  in  the  practice  of  medi- 
cine, to  assert  the  highest  prerogatives  of  the  science  of  medi- 
cine, and  by  unity  of  effort  enforce  them  in  the  interest  of 
and  for  the  welfare  of  mankind,  in  that  governors,  legislative 
bodies,  town  councils,  and  all  others  in  authority  may  come 
to  know  in  the  near  future  that  in  preventive  and  remedial 
medicine  truth  and  science  must  dominate  whim,  caprice, 
charlatanry,  and  mercenary  adventure. 


THE  MEDICAL  SOCIETY  OF  THE  DISTRICT  OF 
COLUMBIA. 

ANNUAL    ADDRESS    OF    THE    PRESIDENT    OF    THE    MEDICAL 

SOCIETY    OF    THE    DISTRICT    OF    COLUMBIA, 

DELIVERED    DECEMBER    18,    1895. 

Gentlemen:  It  gives  me  great  pleasure  to  congratulate 
the  Society  upon  its  continued  prosperity  and  activity.  Dur- 
ing the  year  forty  additional  members  have  been  admittetl  to 


336  ESSAYS  AND  ABDBESSES. 

the  active  list  and  twenty-two  to  the  membersliip  by  invita- 
tion. Every  meeting  has  been  abundantly  supplied  with 
material  for  consideration  and  discussion.  In  fact,  at  times 
the  offers  have  been  so  numerous  that  the  autiiors  were  re- 
quired to  abbreviate  their  essays  to  a  prescribed  limit  of  time. 
The  discussions  have  been  full  and  interesting,  and,  with  rare 
exceptions,  closely  applied  to  the  subject  under  cousideration, 
with  much  less  irrelevancy  than  is  usual  in  impromptu  dis- 
cussions. The  debates  have  shown  also  a  marked  and  com- 
mendable improvement  in  fluency  of  speech  and  conciseness 
and  correctness  of  diction. 

In  consequence  of  my  long  absence  from  the  weekly  meet- 
ings during  the  later  months  of  the  first  session,  I  am  not 
permitted  to  make  any  analysis  of  the  scientific  merits  of  the 
papers  read,  or  even  to  cite  those  of  special  merit;  but  I 
cannot  omit  honorable  mention  of  the  addresses  of  Drs. 
W.  P.  xVTason,  of  Troy;  A.  H.  Smith,  of  New  York; 
William  Osier,  of  Baltimore ;  and  Abraham  Jacobi,  of  New 
York. 

Notwithstanding  the  falling  off  of  the  weekly  attendance 
during  the  later  months  of  the  first  session  of  this  year,  the 
average  attendance  was  sixty-three,  being  an  average  increase 
of  twenty-two  more  than  for  the  corresponding  period  of 
1894.  During  the  present  session  the  largest  number  present 
at  any  one  meeting  was  111,  and  the  average  has  been  94, 
thus  showing  a  largely  increased  attendance  during  the  pres- 
ent year.  These  figures  exhibit  a  most  commendable  interest 
in  the  transactions  of  the  Society.  It  is  hoped  the  impetus 
which  the  Society  has  acquired  in  the  past  two  years  will  con- 
tinue with  unabated  force,  and  that  the  transactions  of  suc- 
ceeding years  may  be  enriched  with  the  evidence  of  that 
progress  which  will,  in  the  future,  as  in  the  past,  continue 
to  elevate  the  science  of  medicine  and  widen  the  scope  of  its 
beneficence. 

Sufficient  time  has  not  yet  elapsed  to  establish  the  wisdom 
and  utility  of  all  the  recommendations  made  in  the  last  annual 


ESSAYS  AM)  ADDRESSES.  337 

address,  and  wlii(;li  wtiic  adoplcd  Uy  (lie  Soriicty.  TlifTf  \h 
no  dissentient  siij^^estion  of  an  mifavoraljle  result  of  their 
diligent  and  impartial  cnfor(;ement. 

I  am  not  witliont  hope  that  the  Society  may  recede  front 
its  dissent  to  the  recommendation  that  its  scope  of  power  and 
nscfnlness  wonld  be  extended  and  enlarji;ed  by  some  method 
<>f  comminucaling  to  the  pid)]ic  tiie  matters  that  refer  to  the 
well-being  and  healthfnlness  of  the  corarannity,  and  in  whi<-h 
there  is  snch  general  interest  as  makes  it  expedient  and  j)roper 
to  present  the  consensus  of  medical  opinion  to  tiie  considera- 
tion of  this  community.  Perhaps  the  expediency  and  pro- 
priety of  such  an  innovation  could  be  more  satisfactorily 
determined  by  the  tentative  approach  to  sucii  policy  under 
the  operation  of  some  temporary  regulation  than  by  a  consti- 
tutional provision. 

The  propriety  of  invitiug,  during  each  year,  one  or  more 
men  from  other  cities  to  deliver  addresses  before  you  has 
proved  eminently  successful  and  instructive;  but  I  must 
renew  the  admonition  to  avoid  the  role  of  the  advertising 
medium,  and  restrict  such  invitations  to  physicians  whose 
eminent  success  and  high  character  preclude  even  the  sugges- 
tion of  motives  of  doubtful  repute,  and  to  condemn  by  posi- 
tive refusal  all  personal  solicitations. 

Milk  Legislation. 

The  efforts  of  the  Committee  on  Legislation  to  secure  the 
enactment  of  a  law  to  regulate  the  supply  and  sale  of  milk  in 
this  District  have  not  been  entirely  satisfactory.  The  bill, 
H.  of  B.  jSTo.  8231,  which  had  received  the  indorsement  of 
the  Commissioners  of  the  District  and  of  this  Society,  passed 
the  House  of  Representatives  without  alteration,  but  the  Sen- 
ate Committee  on  the  District  of  Columbia  suggested  so  many 
amendments,  which  so  completely  eliminated  its  penal  provi- 
sions, that  I  presented  to  the  Senate  the  following  remon- 
strance to  their  adoption: 


338  ESSA  YS  AND  ADDEESSES. 

53d  Congress,  \  SENATE.  J  Mis.  Doc. 

3d  Session.    J  (     No.  96. 

IN  THE   SENATE   OF   THE   UNITED   STATES. 

February  8,  1895. — Laid  on  the  table  and  ordered  to  be 
printed. 

February  15,  1895. — Ordered  to  be  reprinted,  with 
appendix. 

Mr.  Faulkner  presented  the  following  memorial,  from  the 
Medical  Society  of  the  District  of  Columbia,  favoring  the 
passage  of  H.  R.  8231,  entitled  ''An  Act  to  regulate  the  sale 
of  milk  in  the  District  of  Columbia,"  and  appendix. 

To  the  honorable   Senate  of  the   United   States   in   Congress 
assembled : 

The  Medical  Society  of  the  District  of  Columbia  respect- 
fully represents  to  the  honorable  Senate  that  the  bill  of  the 
House  of  Representatives,  No.  8231,  entitled  "  An  Act  to 
regulate  the  sale  of  milk  in  the  District  of  Columbia,  and  for 
other  purposes,"  now  pending  before  the  honorable  Senate, 
originated  with  the  Commissioners  of  the  District  of  Cohun- 
bia,  and  was  submitted  by  said  Commissioners  to  this  Society 
for  examination  and  approval.  After  a  thorough  considera- 
tion til  is  Society  gave  to  tlie  bill,  as  it  has  been  passed  by  the 
House  of  Representatives,  its  unanimous  and  unqualified  in- 
dorsement. Subsequently  the  same  bill  was  approved  by  the 
legal  adviser  of  the  Commissioners  and  by  Dr.  D.  E.  Salmon, 
Chief  of  the  Bureau  of  Animal  Industry  of  the  Department 
of  Agriculture. 

The  Medical  Society  of  the  District  of  Columbia  respect- 
fully represents  to  the  honorable  Senate  that  the  purpose  of 
the  bill,  as  passed  by  the  House  of  Representatives,  is  to 
secure  to  the  residents  of  this  District  a  supply  of  good,  un- 
polluted, and  unadulterated  milk,  which  cannot  be  secured 
except  through  the  enactment  and  enforcement  of  a  law  that 


ES8A  YN  A  NIJ  A  I)  l>  li  h'SSKS.  .*',;}(> 

will  coiii))(;l  Liu:  luillc  proiiiKMirs  and  (iiialcr.s  lo  Hii|)j)ly  tli';  food 
at  a  fixed  sbindard  of  ([nality,  purity,  and  freedom  from  the 
germs  of  disease. 

The  consensus  of  mcidical  opinion  (istablisheH  the  fad  that 
the  present  method  of  prodnetion,  eollef^tion,  and  Hnj)ply  of 
milk  in  this  District  is  one  of  the  most  dan<reron8  of  human 
industries  in  that  the  supply  is  suhjeeted  to  contamination 
with  the  ujcrms  of  disease;  from  infected  raili<-yie]<linj^  animals 
and  from  persons  employed  about  the  dairy-farms.  It  is 
known  that  milk  from  tuberculous  cows  will  convey  tuber- 
culosis, the  most  dreadful  and  fatal  of  all  diseases  in  this 
country,  to  human  beings,  and  more  especially  to  young  chil- 
dren fed  upon  such  infected  milk. 

It  is,  however,  not  only  disease  in  the  cow  whicli  may  be 
conveyed.  It  often  conveys  virulent,  infectious  diseases  from 
the  dairyman's  family  to  his  customers.  Typhoid  fever,  sear- 
let  fever,  and  diphtheria  have  been  very  frequently  conveyed 
by  the  transmission  of  the  germs  of  these  diseases  from  the 
farm  to  the  consumers  of  the  milk.  By  reference  to  the 
appendix  it  may  be  seen  that  138  epidemics  of  typhoid 
fever,  74  of  scarlet  fever,  and  28  of  diphtheria  have  been 
positively  traced  to  milk  infected  with  the  germs  of  these 
diseases. 

Milk  is  such  an  admirable  medium  favorable  to  the  growth 
of  bacteria  that  even  when  taken  from  cattle  entirely  healthy, 
and  on  farms  free  from  infectious  and  contagious  diseases,  it 
will,  unless  properly  prepared  for  transportation,  undergo 
such  rapid  changes,  induced  by  bacteria,  that  it  may  be  ren- 
dered unfit  for  human  food,  especially  for  young  children, 
before  it  can  be  delivered  to  the  consumers. 

In  view  of  the  foregroino-  facts  it  becomes  an  absolute 
necessity,  in  the  interest  of  sanitary  science  and  preventive 
medicine,  that  the  sale  of  milk  in  this  District  should  be 
regulated  by  such  legislation  as  Avill  afford  that  protection 
from  preventable  causes  of  disease  which  the  welfare  of  the 
comnumitv  demands. 


340  JSSSA  YS  AND  ADDRESSES. 

The  proper  inspection  of  milk  requires  a  chemical  and 
bacteriological  examination  by  persons  skilled  in  such  exam- 
inations of  dairy-products.  To  such  investigations  must  be 
added  personal  inspection,  at  intervals  not  to  be  fixed  or 
known  to  the  dairymen  of  the  herds  and  farms,  that  unfit 
and  improper  feeding  and  housing  may  be  detected.  The 
freedom  of  the  herd  from  tuberculosis  can  be  positively  and 
only  determined  by  the  tuberculin-test.  So  also  is  a  personal 
inspection  of  the  farm  necessary  to  prevent  the  infection  of 
the  milk  by  the  germs  of  diseases,  such  as  typhoid  fever, 
scarlet  fever,  and  diphtheria,  with  which  some  of  the  em- 
ployes may  be  afilicted. 

The  Medical  Society  of  the  District  of  Columbia  fears  that 
the  proposed  amendments  to  House  bill  No.  8231  are  exclu- 
sively in  the  interest  of  milk  producers  and  dealers,  and,  if 
adopted,  will  promote  and  protect  more  aggressive  frauds 
than  have  heretofore  been  perpetrated  upon  the  consumers 
of  milk  in  this  District,  by  more  frequent  and  deliberate 
adulterations  and  pollution  of  the  milk  supplied  to  them. 
This  apprehension  grows  out  of  the  fact  that  in  every  section 
of  the  bill  defining  an  offence  its  violation  is  qualified  by  the 
proposed  insertion  of  the  words  "  knowledge,  known,  or 
knowingly,"  which  it  is  believ^ed  will  render  those  provisions 
of  the  bill  inoperative.  In  the  case  of  The  People  v.  Kebler, 
New  York  Court  of  Appeals,  the  Court  said: 

"  Experience  has  taught  the  lesson  that  repressive  measures 
which  depend  for  their  efficiency  upon  proof  of  the  dealer's 
knowledge,  and  of  his  intent  to  deceive  and  defraud,  are  of 
little  use  and  rarely  accomplish  their  purpose." 

The  Society  begs  leave,  furthermore,  to  suggest  that  the 
bill,  with  the  pending  amendments,  will  so  increase  the 
profits  of  disreputable  producers  and  dealers  that  those 
wishing  to  supply  good  and  unpolluted  milk  will  be  driven 
from  the  trade,  and  that  the  supply  of  unadulterated  and 
infected  milk  will  be  increased,  to  the  detriment  of  the  con- 
sumers, and  the  Society  therefore  prays  that  the  honorable 


je;-s'-s'-4 ys  an/)  add iiessks.  ?a\ 

Senate    will    (loiuMir    in    tlu:    ciiacttiiciit    of    House    hill    Su. 
8231. 

I  have  the  honor  to  he  yonr  obedient  servant, 

Samuki>  C.  Busey,  M.D., 

President  of  the  Medical  Society  of  the  District  of  Columbia. 

At  a  subsequent  hearing  before  the  suheommittee,  eom- 
posed  of  Senators  Faulkner,  Plunton,  and  Gallinger,  the 
committee  was  induced  to  recede  from  some  and  to  modify 
others  of  the  proposed  araendmi'nts,  so  that,  finally,  the  bill 
was  passed  as  the  law  now  exif-ts.  This  law  is  a  step  far  in 
advance  of  the  previous  regulations  of  the  supply  and  sale  of 
milk,  but  falls  short,  in  many  particulars,  in  securing  to  the 
consumers  of  milk  in  this  District  a  supply  free  from  adul- 
teration and  pollution. 

At  this  hearing  it  was  strangely  apparent  that  legislators 
of  such  high  distinction  and  intellectual  attainments  should 
be  so  reluctant  to  accept  the  clinical  evidence  of  milk-infec- 
tion with  germs  of  contagious  diseases,  and  refuse  the  full 
measure  of  protection  which  this  community  demands.  In  a 
recent  paper  read  before  this  Society  the  filthy  contamination 
of  the  milk-supply  of  this  city  was  so  fully  set  forth  that  no 
one  could  doubt  its  disease-producing  qualities. 

Report  of  Zymotic  Diseases. 

The  experience  of  the  present  year  has  clearly  demonstrated 
the  necessity  of  some  compulsory  legislation  requiring  every 
physician  to  report  to  the  Health  Department  every  case  of 
zymotic  disease  occurring  in  his  practice.  No  system  of 
sanitation  or  preventive  medicine  can  be  effective  without  the 
knowledge  of  the  number  and  location  of  every  such  case  of 
disease,  at  all  times  of  the  year,  and  more  especially  during 
the  prevalence  of  an  epidemic.  If  every  case  of  typhoid  fever 
that  has  occurred  in  this  District  during  the  present  year 
had  been  promptlv  reported  to  the  Health  Department,  the 
fair  fame  and  healthfulness  of  this  city  would  not  have  been 


342  ESSAYS  AND  ADDRESSES. 

taruished  by  the  exaggerated  and  detrimental  reports  which 
have  been  spread  all  over  the  country,  and  the  cases  due  to 
milk-  and  water-infection  and  soil-pollution  could  have  been 
classified  with  almost  absolute  accuracy.  There  would  liave 
been  fewer  cases  and  a  loAver  death-rate.  The  constantly  reiter- 
ated statement  that  this  or  that  family  or  "  my  people  "  would 
not  permit  such  reports  is  a  fallacy  unworthy  of  respectful  con- 
sideration, when  the  mortuary  columns  of  the  local  press  are 
teeming  with  reports  of  distress  and  sorrow  that  bring  home 
to  every  household  the  inadequacy  of  municipal  protection 
from  preventable  diseases.  Every  good  citizen  will  willingly 
submit  to  a  law  that  offers  protection  from  sorrow,  suffering, 
expense,  deaths,  and  funerals. 

Medical  Practice  Law. 

The  history  of  the  efforts,  disappointments,  and  failures  of 
this  Society  to  secure  the  enactment  of  a  law  to  regulate  the 
practice  of  medicine  in  this  District  has  not  been  written.  It 
therefore  becomes  my  duty,  as  the  chairman  of  the  committee 
now  in  charge  of  legislation,  to  record  in  some  permanent 
form  the  proceedings  of  this  committee.  In  1893,  some  time 
previous  (15  months)  to  the  appointment  of  the  present  com- 
mittee, the  first  effort  was  made,  which  culminated  in  the 
enactment  of  a  law,  entitled  ''  An  Act  to  incorporate  the 
Eclectic  Medical  Society  of  the  District  of  Columbia,"  which 
endowed  seven  persons,  therein  named,  not  one  of  whom  was 
a  member  either  of  this  Society  or  of  the  Medical  Association 
of  the  District  of  Columbia,  ''  with  all  the  rights,  privileges, 
and  immunities  that  appertain  to  other  medical  societies  in 
the  District  of  Columbia."  This  statute  confers  upon  that 
Society  the  corporate  power  to  license  persons  to  practise 
medicine  in  this  District. 

In  1870  Congress  passed  ''An  Act  to  incorporate  the  Wash- 
ington Homoeopathic  Medical  Society,"  in  which  it  is  provided 
that  said  Society  shall  examine  and  ''  license  to  practise  medi- 
cine or  surgery  in  the  District  of  Columbia  "  only  such  can- 


1':SSA  VS  A  NI)  A  I)  I)  I!  h'.SSKS.  343 

(lldatcH  iiH  hIiuII  "  Hii.stain  a  ^ood  moral  (^haract'-r,  and  ■-liall 
present  lettxirs  ieKtiinoiiial  of  llicir  (|ii;ilifieation.s  froin  Hotno 
legally  anil lori/ed  nie,di<'ai  institution."  In  abstraet,  tliis  is 
a  more  specific  definition  of  the  (|nalifieations  of  tlu-  licentiate 
than  is  set  forth  in  the  charter  of  this  Society,  granted  in 
1819,  which  prescribes  that  it  shall  elect  a  board  of  exam- 
iners, "whose  duty  it  shall  be  to  grant  licenses  to  such  medical 
and  chlrnrgical  genth^nKMi  as  they  may,  upon  fidl  examina- 
tion, jnilge  adequate  to  commence  the  practice  of  the  medical 
and  chirurgical  arts,  or  as  may  produce  diplomas  from  some 
respectable  college  or  society."  The  charter  of  the  Medical 
Society  of  the  District  of  Columbia,  therefore,  ordains  the 
alternative  of  an  examination  of  or  the  presentation  of  a 
diploma  by  its  licentiates,  which  was  eliminated  from  the 
charter  of  the  Washington  Homoeopathic  Medical  Society. 

Twenty-three  years  after  the  date  of  the  charter  of  the 
Washington  Homoeopathic  Medical  Society,  1893,  the  Con- 
gress of  the  United  States  chartered  a  third  medical  society, 
"  endowed  with  all  the  rights,  privileges,  and  immunities  " 
of  the  two  senior  medical  societies,  and  empowered  it  "  from 
time  to  time  to  make  such  by-laws,  rules,  and  regulations  as 
they  find  necessary,  and  do  and  perform  such  other  things 
as  may  be  requisite  for  carrying  this  Act  into  effect,  and 
which  may  not  be  repugnant  to  the  Constitution  and  laws  of 
the  United  States."  The  endowment  of  a  medical  society 
with  such  extraordinary  powers  and  rights  constitutes  a  retro- 
grade movement  in  medical  education,  and  may  establish  such 
an  obstacle  to  the  attainmenr,  of  the  higher  standard  of  knowl- 
edge in  medicine  as  to  invoke  remonstrance,  pushed  to  the 
limit  of  resistance.  A  liberal  and  perhaps  fair  interpretation 
of  the  provisions  of  this  Act  might  possibly  confer  the  cor- 
porate power  to  supply  this  community  with  "  physicians, 
not  less  in  number  than  its  population,  without  licenses  or 
diplomas  from  responsible,  respectable,  or  other  legally  au- 
thorized medical  college,  society,  or   institution,   and    inde- 


344  ESSA  YS  AND  ADDRESSES. 

pendeiitlj  of  the  aunual  iuflux  of  the  quacks,  charlatans,  and 
impostors  driven  hither  from  the  States  and  Territories. 

Notwithstanding  these  faihires  and  disappointments,  this 
Society  accepted  the  invitation  of  the  Washington  Homoeo- 
pathic Medical  Society  to  unite  in  the  preparation  of  a  bill 
that  would  be  satisfactory  to  both.  The  joint  committee  failed 
to  agree,  and  this  Society  completed  the  preparation  of  the 
bill  that  was  introduced  into  Congress  July  7,  1894,  a-nd  is 
known  as  House  bill  No.  7661,  entitled  "  A  bill  to  regulate 
the  practice  of  medicine  and  surgery  in  the  District  of  Colum- 
bia and  for  other  purposes."  This  bill  was  referred  "  to  the 
Committee  on  the  District  of  Columbia  and  ordered  to  be 
printed,"  and  there  it  remained  without  further  consideration. 

In  October  following  (1894)  this  Society  reorganized  its 
Committee  on  Legislation,  which  proceeded  immediately  to 
discharge  the  duties  imposed  upon  it.  Upon  its  recommen- 
dation the  Society  amended  House  bill  No.  7661  by  elimi- 
nating from  its  provisions  every  reference  to  the  Homoeopathic 
and  Eclectic  Medical  Societies.  These  emendations  grew  out 
of  the  failure  of  the  conferences  of  the  previous  committee  of 
this  and  the  Homoeopathic  Society  to  agree  in  framing  a  bill 
satisfactory  to  the  latter  society,  and  it  was  therefore  deemed 
most  expedient  by  the  committee,  then  in  charge,  for  this 
Society  to  present  its  views  in  a  distinctly  concrete  form, 
absolutely  free  from  any  proposition  of  compromise  with  any 
and  all  other  medical  societies,  and  thereby  compel  the  dis- 
.senting  societies  to  commit  themselves  to  definite  views  and 
propositions,  as  the  basis  of  an  amicable  adjustment  of  differ- 
ences by  the  legislative  authority.  As  thus  amended  it  was 
presented,  December  10,  1894,  by  the  Hon.  J.  T.  Heard, 
and  is  known  as  House  bill  No.  8133. 

Subsequently,  December  17,  1894,  the  Hon.  H.  W.  Blair 
offered  a  bill  to  regulate  the  practice  of  medicine  in  the  Dis- 
trict of  Columbia,  known  as  House  bill  No,  8229,  which  was 
intended  to  enact  "  that  the  Physio-Medical  School  of  Medi- 
cine shall  have  all  the  rights,  privileges,  and  protection  that 


ESSA  YS  A  Nl)  A  I)  DRESSES.  'M  5 

is  or  may  Ix!  providtnl  hy  law  for  allopaflii'-,  liomaiOpatliio, 
oi'  any  scliool  of  mudiciiu!  witliiii  tlu;  DiHlrict  of  Columbia." 

After  a  preliminary  hearing  of  tlie  H.  of  Jl,  Committee 
on  the  District  of  Columbia,  at  which  V)ill  No.  8133  was 
fully  explained  and  the  object  of  this  Society  in  seeking  its 
enactment  was  fully  set  forth,  it  was  referred  to  the  Com- 
missioners of  the  District  of  Columbia  for  consideration 
and  recommendation.  As  is  customary,  the  Commissioners 
granted,  December  19,  1894,  a  special  hearing  to  those 
interested  in  the  bill,  at  wiiich  there  were  present  committees 
representing  this,  the  Washington  Homoeopathic  and  Eclectic 
Medical  Societies,  and  several  other  persons.  At  this  con- 
ference a  most  pronounced  opposition  to  bill  No.  8133  was 
developed  and  urged  with  considerable  force  and  pertinacity; 
some  objecting  to  any  legislation  on  the  subject,  and  others  to 
the  exclusive  provisions  of  the  bill.  The  Washington  Homrjeo- 
pathic  INIedical  Society  offered  a  substitute,  identical  in  some 
of  its  sections  with  House  bill  No.  8133,  but  differing  in  the 
method  of  establishing  and  enforcing  a  uniform  standard  of 
qualification.  Its  committee  not  only  conceded  the  necessity 
of  a  law  to  regulate  the  practice  of  medicine  in  this  District, 
but  based  its  action  upon  the  broad  statement  that  the  laws 
of  this  District ''  were  totally  inadequate  to  protect  its  citizens 
from  imposition," 

This  substitute  bill  was  subsequently,  January  23,  1895, 
introduced  into  the  Senate,  and  is  known  as  Senate  bill  No, 
2645,  and  was  referred  to  the  Commissioners,  by  whom  a 
second  special  hearing  was  granted,  which  was  in  effect  a 
recapitulatiou  of  what  occurred  on  December  19,  1894.  At 
this  stage  of  the  proceedings  the  whole  question  remained  in 
abeyance  until  the  report  of  the  Commissioners  was  made  in 
the  form  of  a  bill  introduced  into  the  Senate  by  Senator  Har- 
ris, January  31,  1895,  and  known  as  '^  the  Commissioners' 
bill "  or  Senate  bill  No.  2685  (53d  Congress,  3d  session). 
The  bill  was  modelled  after  the  laws  of  New  York  and  Penn- 
sylvania, and  would  have  been  accepted  by  the  committee  of 


346  ESSAYS  AND  ADDRESSES. 

this  Society  but  for  several  interpolations,  more  especially  the 
following : 

''  Any  applicant  intending  to  practise  in  the  District  of 
Columbia  any  system  of  medicine  or  treatment  other  than 
the  regular  or  homoeopathic  or  eclectic  system,  and  stating 
such  intention  in  his  application,  shall  be  exempt  from  such 
part  of  any  examinations  to  which  he  may  be  subjected  as 
relates  exclusively  to  the  treatment  of  disease,  but  such  appli- 
cant shall  submit  in  all  other  branches  to  the  same  examina- 
tions as  are  required  of  other  applicants,  and  shall  be  exam- 
ined by  such  boards  of  examiners  as  may  be  designated  by 
the  board  of  medical  supervisors:  Provided,  That  any  per- 
son who  may  avail  himself  of  the  exemption  allowed  by  this 
clause,  and  who  receives  a  license  under  this  Act,  shall  cause 
at  all  times  to  be  plainly  affixed  to  any  sign  or  signs  he  may 
erect  or  cause  to  be  erected,  and  to  any  prescription-blanks, 
bill-heads,  and  other  articles  he  may  use  in  his  professional 
work,  and  to  be  inscribed  in  any  advertisement  he  may  cause 
to  be  displayed,  the  designation  of  the  system  of  medicine  or 
treatment  employed  by  him  for  the  cure  or  relief  of  disease." 

To  this  bill  your  committee  addressed  the  following  protest 
to  the  Commissioners,  to  which  no  reply  has  been  made: 

"1545  I  St.,  N.  W., 
"Washington  City,  February,  1895. 

'^Hon.  Commissioners  of  the  District  of  Columbia: 

''  Gentlemen:  I  am  instructed  by  the  Committee  on 
Legislation  of  the  Medical  Society  of  the  District  of  Colum- 
bia to  communicate  to  your  honorable  board  the  objections 
of  said  committee  to  several  provisions  of  the  bill  known  as 
the  '  Commissioners'  bill,'  and  -entitled  'A  bill  to  regulate 
the  practice  of  medicine  and  surgery,  to  license  physicians 
and  surgeons,  and  to  punish  persons  violating  the  provisions 
thereof  in  the  District  of  Columbia.' 

"  The  committee  of  the  Medical  Society  suggests  that  sec- 
tion 1  be  so  amended  that  not  more  than  two  of  the  board  of 


ESHA  YS  A  NJ)  A  DDRENHEH.  .'{47 

medical  .supervisors  sIimII  !)<■  ;ij)|M»iiit((l  rniin  <itli('r  of  the 
three  syHtems  of"  medicine  recognized  in  the  hill,  ho  that  it 
will  be  impossible  for  either  of  these  systemH  of  medicine  tf) 
acquire  a  majority  of  said  board  of  medicul  suj)ervisorH. 

''  The  committee  recommends  the  omission  of  all  of  section 
2  after  the  word  '  surgery,'  in  line;  80.  This  clause  provides 
for  the  licensing  oC  any  applicant  intending  to  j)ractise  in  the 
District  of  Columbia  any  system  of  medicine  or  treatment 
other  than  the  regidar  or  homoeopathic  or  eeleetio  system, 
and  is  objectionable  not  only  because  it  is  an  invitation  to 
the  horde  of  charlatans,  pretenders,  and  impostors  driven 
from  the  States  by  the  enforcement  of  medical  practice  laws 
which  prevent  the  prosecution  of  their  nefarious  and  merce- 
nary impositions  to  settle  in  this  District,  now  the  common 
rendezvous  of  such  disreputable  classes,  but  it  is  a  direct  and 
positive  insult  to  every  intelligent  and  educated  physician  in 
that  it  ignores  all  and  every  method  and  system  of  prelimi- 
nary and  technical  education,  and  is  in  direct  conflict  with  the 
reforms  and  elevated  standard  of  medical  education  which 
the  profession  is  putting  in  active  operation  throughout  the 
country.  There  is  now  in  this  city  one  system,  claiming  to 
have  a  charter  obtained  under  the  provisions  of  the  general 
incorporation  law,  with  one  emeritus  professor  and  one  gradu- 
ate, who  signed  the  certificate  of  his  own  graduation.  Under 
the  clause  referred  to,  unlike  systems  but  similar  institutions 
may  be  chartered  at  the  will  of  any  drug  or  medicine  fiend, 
and  be  entitled  to  a  license  to  practise  the  science  of  medicine 
in  this  District. 

"■  The  same  clause  of  section  3,  lines  45  to  47,  compels 
such  applicant,  when  licensed,  to  insert  '  in  any  advertise- 
ment he  may  cause  to  be  displayed  the  designation  of  the 
system  of  medicine  or  treatment  employed  by  him  for  the 
cure  and  relief  of  disease.'  Thus  not  only  is  the  fraud  to 
be  licensed,  but,  when  licensed,  he  is  required  to  commit  a 
fraud  upon  the  credulous  public  by  advertising  to  do  that 
which  he  knows  he  cannot  do. 


348  ESSAYS  AND  ADDRESSES. 

"  The  third  objection  to  the  '  Coiuraissioners'  bill'  refers 
to  the  omission  of  any  provision  prohibiting  '  publicly  adver- 
tising ability  to  treat  and  cure  diseases,'  as  is  usual  in  medical 
practice  laws.  Such  a  prohibition  would  banish  from  this 
District  every  such  disreputable  pretender  and  protect  this 
community  from  that  class  of  frauds  and  impostors  driven 
from  the  States  and  Territories.  It  is  idle  to  claim  that  such 
result  can  be  accomplished  by  the  enforcement  of  the  rules, 
regulations,  and  codes  of  medical  ethics,  when  only  such  per- 
sons can  be  made  amenable  to  such  rules  and  codes  as  may 
have  acquired  membership  in  ethical  organizations.  The 
advertising  charlatan  has  no  code  but  that  of  fraud  and 
criminal  deception. 

'^  The  Medical  Society  of  the  District  of  Columbia  is  will- 
ing to  accept  any  one  of  the  forty-one  medical  practice  laws 
now  in  force  in  the  States  and  Territories  of  the  country, 
except  the  Alabama  law,  to  which  it  objects  because  of  a  pro- 
vision somewhat  similar  to  the  objectionable  clause  in  section 
3  of  the  '  Commissioners'  bill,'  but  which  is  more  securely 
guarded,  because  of  the  supervision  of  the  State  Medical 
Society. 

"  The  committee,  therefore,  requests  the  Board  of  Com- 
missioners so  to  modify  the  bill  S.  2685,  known  as  the 
'  Commissioners'  bill,'  that  it  may  give  to  it  its  unqualified 

support. 

"  I  have  the  honor  to  be, 

''  Your  obedient  servant, 

"  Samuel  C.  Busey,  M.D., 

"Chairman  of  Committee  of  the 
"  Medical  Society  of  the  District  of  Columbia." 

At  a  second  hearing  by  the  House  Committee  on  the  Dis- 
trict of  Columbia,  at  which  were  considered  the  Commissioners' 
bill  and  the  substitute  bill  (S.  2645)  of  the  Homoeopathic 
Medical  Society,  there  were  present  representatives  of  the 
three  chartered  medical  societies,  the  Physio-Medical  School, 
White    Cross    University   of    Science,    and    the    Vivopathic 


ESSAYS  AND  ADDIiESSES.  349 

System,  and  some  iiidividiiiils  with  nricvunrcH  in  gcrjoral. 
The  PliyHJo-Modical  Seliool  set  forth  with  h)iid  and  vehement 
clamor  its  Hupfr-excic^llent  and  wv.u  tranHcciKlcnt  |)()\v<'rH  and 
attributes  tliat  would  "  eventually  eon(juer  the  world  of  medi- 
cal science,"  and  asserted  with  convulsive  triumph  that  its 
devotees  "  did  not  carry  their  diplomas  on  pap(!r,  but  in 
their  heads."  The  White  Cross  University  and  Vlvopathic 
System  was  opposed  to  any  proposition  to  ''establish  a  medi- 
cal monopoly,"  because  it  ''  did  not  need  much  teaching," 
citing  in  proof  thereof  the  fact  that  ''  the  university  had 
granted  but  one  diploma,"  and  that  ''  to  one  who  came  with 
a  diploma  from  the  eclectic  school."  Altogether,  this  dis- 
cussion proved  more  entertaining  than  instructive,  but  was, 
nevertheless,  convincing  of  the  necessity  of  additional  legis- 
lation. 

In  consequence  of  the  opposition  to  the  Commissioners' 
bill,  which  no  one  would  aceej)t  as  a  whole,  and  was  only 
accepted  in  part  by  your  committee,  the  Homoeopathic  sub- 
stitute bill  assumed  greater  importance  as  the  basis  of  adjust- 
ment of  the  differences  between  that  and  this  Society,  and 
would  probably  have  been  adopted  by  the  House  Committee 
but  for  the  opposition  of  your  committee  to  several  of  its 
provisions.  The  committee  in  charge  of  it  made  sundry  im- 
portant concessions,  and  manifested  such  spirit  of  conciliation 
that  an  agreement  seemed  to  be  within  actual  possession. 
Your  committee,  however,  after  more  deliberate  considera- 
tion, directed  the  following  communication  to  be  sent  to  the 
Committee  of  the  Homoeopathic  Medical  Society  : 

"15-15  I  St.,  X.  W.. 
"  Washixgtok,  D.  C,  February  ~,  1S95. 

''  Dear  Dr.  Custis:  I  am  directed  by  the  committee  of 
the  Medical  Society  of  the  District  of  Columbia  to  inform  you 
that  it  cannot  accept  your  bill,  even  with  the  amendments 
which  you  propose.      The  main  objections  to  the  bill  are: 

'^First.  It  does  not  establish  a  uniform  standard  of  quali- 
fication. 


3a0  ^SSA  YS  AND  ADDRESSES. 

"Second.  There  is  no  or  inadequate  supervision  of  the  acts 
of  the  separate  examining  boards. 

"Third.  That  any  two  of  the  examining  committee  can 
license  any  applicant,  however  deficient  his  qualifications 
may  be. 

"  I  am  instructed,  furthermore,  to  inform  you  that  the 
committee  will  urge  the  Commissioners'  bill,  but  will  seek  to 
amend  it  by  striking  out  the  clause  inviting  other  and  new 
systems  to  apply  for  license;  by  inserting  a  provision  against 
the  advertising  charlatan  ;  and,  lastly,  by  limiting  the  ap- 
pointment of  the  Board  of  Supervisors  so  that  not  more  than 
two  can  be  of  the  same  school  of  medicine. 
''  I  have  the  honor  to  be 

"  Your  obedient  servant, 

'^  Samuel  C.  Busey,  M.D., 

"  Chairman  of  Committee  of  the  Medical  Society 
"  of  the  District  of  Columbia." 

This  communication  concluded  the  conferences  and  corre- 
spondence. Three  days  later  I  was  directed  to  address  the 
following  communication  to  the  Senate  Committee  on  the 
District  of  Columbia  : 

"  1545  I  St.,  N.  W., 
"  Washington,  D.  C,  February  10, 1895. 

"Senator  Isham  G.  Harris, 

"  Chairman  Committee  of  District  of  Columbia. 

''Dear  Sir:  I  am  instructed  by  the  committee  of  the 
Medical  Society  of  the  District  of  Columbia  to  inform  the 
Committee  of  the  Senate  on  the  District  of  Columbia  that  it 
is  opposed  to  the  passage  of  any  of  the  bills  now  pending  to 
regulate  the  practice  of  medicine  in  the  District  of  Columbia, 
because  of  their  failure  to  secure  a  uniform  standard  of  medi- 
cal education,  and  to  prevent  discrimination  in  favor  of  or 
against  individuals. 

"1  am  instructed  also  to  state  that  the  Medical  Society 
of  the  District  of  Columbia  is  willing  to  accept  any  of  the 
medical  practice  laws  in  operation  in  the  States  and  Territo- 
ries except  that  of  the  State  of  Alabama. 


KSSA  Y.S  AND  A  DDIIKSSKS.  :>:>] 

"  The  coimnittee  begs  that  tlie  Senate  Committee  will  grant 
it  an  opportunity  to  be  heard  before  i(  fonehideH  itH  consitlera- 
tion  of  th(!  Hiibjcel. 

"'  I  luivc  the  honor  to  be 

''Your  obedient  servant, 

''Samuel  C.  Buhey,  M.D., 

"  ChiiiriTiuii  of  f;ominlttce  of  the  Mcfllcal  S^jclety 
"of  Miu  iJlslrlct  of  Columblii." 

A  few  days  later  I  was  verbally  informed  that  the  Senate 
Committee  iiad,  for  want  of  time,  declined  to  consider  the 
subject  during  the  session. 

The  foregoing  history  points  to  the  following  conclusions  : 

1.  No  bill  containing  the  clause  in  the  Commissioners'  bill 
relating  to  other  and  new  systems  will  be  satisfactory  either 
to  this  or  the  Homceopathic  Medical  Society,  and  cannot  be- 
come a  law  without  their  concurrence. 

2.  No  bill  can  become  a  law  that  is  not  satisfactory  to  both 
of  these  medical  societies. 

3.  No  bill  can  become  a  law  without  the  assent  and  sup- 
port of  the  Homoeopathic  Medical  Society. 

4.  No  law  will  be  adequate  or  effective  that  does  not  annul 
the  extraordinary  powers  and  privileges  granted  the  Eclectic 
Medical  Society. 

5.  Constant  vigilance  on  the  part  of  this  Society  may  be 
imperative  to  prevent  the  passage  of  some  law  relating  to  the 
practice  of  medicine  in  the  District  of  Columbia  more  objec- 
tionable than  the  charter  of  the  Eclectic  Medical  Society. 

With  these  facts  and  conclusions  before  you,  what  course 
will  this  Society  pursue  ?  Will  you  abandon  the  issue  and 
leave  the  field  of  your  labors  to  charlatanry,  imposition,  and 
fraud,  or  will  you  follow  the  example  set  by  the  medical  fra- 
ternity in  forty-one  States  and  Territories "?  You  made  the 
issue,  and  every  consideration  of  duty  to  yourselves  and  to 
this  community  commands  its  prosecution  to  a  final  and  sat- 
isfactory conclusion.     Seventy-seven  years   ago   twenty-one 


352  ESSAYS  AND  ADDRESSES. 

qualified  physicians,  animated  by  the  courage  of  their  con- 
victions and  the  obligations  of  imperative  duty,  united  in  an 
organization  to  protect  the  citizens  of  the  District  of  Columbia 
from  the  wrongs  and  injuries  perpetrated  by  the  horde  of 
charlatans  and  pretenders  that  had  flocked  here  like  vultures 
to  prey  upon  the  innocent  and  credulous  sick  and  suffering. 
Now  that  the  evils  aud  atrocities  have  been  multiplied  to  the 
utmost  limit  of  wrong,  injury,  and  crime,  will  you,  with  an 
organization  far  greater  in  number  and  power,  do  less  ?  In 
forty-one  States  and  Territories  public  opinion,  the  welfare  of 
society,  and  unanimity  of  medical  opinion  have  compelled  the 
Legislatures  to  guarantee  by  statute  law  the  protection  which, 
because  of  such  protective  legislation,  is  all  the  more  needed 
by  this  community,  that  the  perpetration  of  such  wrongs  and 
injuries  may  at  least  be  limited  to  such  agencies  and  instru- 
mentalities as  may  have  acquired  vested  rights  in  ignorance, 
deception,  and  fraud. 

There  are  in  this  District  five  medical  schools  and  several 
medical  societies  chartered  by  Acts  of  Congress  or  under  the 
provisions  of  the  general  incorporation  law,  authorized  and 
empowered  to  license  persons  to  practise  the  art  and  science 
of  medicine  without  a  uniform  and  even  without  any  stand- 
ard of  qualification  beyond  the  ability  and  willingness  of  the 
licentiate  to  pay  the  required  fees  or  give  promissory  notes 
for  the  payment  of  the  same ;  and  under  the  provision  of  the 
general  incorporation  law  any  dozen  citizens  may  obtain  a 
charter,  upon  the  payment  of  the  fee  for  the  record  of  the 
same,  authorizing  them,  as  a  body  corporate,  to  confer  the 
degree  of  M.D.  at  their  pleasure  aud  will.  To  these  must 
be  added  the  system  of  voodoo  medicine,  with  its  shocking 
sorceries  and  incantations;  the  physio- medical  system  of  in- 
tuitive medicine,  with  its  supernatural  attributes ;  and  the 
White  Cross  University  aud  Vivopathic  System,  boasting  of 
'' little  teaching"  as  the  only  necessary  qualification  of  its 
graduates. 


ESS  A  YS  A  Nl)  A  I)  DRESSES.  363 

If  sii(;li  (lata  an;  lutt  HiiirHmint  incentive  to  unite  y'»"  in 
some  eominon  <  ITorl,  to  correeL  uhiiHes  and  (!Ht;il)li.-^li  a  hit^lier 
and  uniform  standard  of  UHidical  education,  then  examine;  the 
records  of  the  "  examininf^-bourda  "  in  tiie  States  where  medi- 
cal practice  laws  are  in  force.  I  will  only  cite  that  of  the 
'^  Board  of  Medical  Examiners  "  of  Vir<!;inia,  from  the  date 
of  its  orj^anization,  January  1,  1885,  to  Oetoher,  1895  ;  dur- 
ing which  period  it  rejected,  on  first  examinations,  two  hun- 
dred and  sixty-nine  out  of  nine  hundred  and  eighteen  appli- 
cants for  license,  or  29.30  per  centum  of  graduates  of  seventy- 
five  medical  schools,  including  some  of  the  highest  repute, 
located,  with  three  exceptions,  in  eighteen  States  and  Terri- 
tories of  this  country. 

Of  the  six  New  England  States,  Maine,  Massachusetts,  and 
New  Hampshire  have  no  legal  requirement  for  the  practice  of 
medicine. 

First  class.  In  Alabama,  Arkansas,  Florida,  Maryland, 
Minnesota,  Mississippi,  New  Jersey,  New  York,  North 
Carolina,  North  Dakota,  Pennsylvania,  South  Dakota, 
Rhode  Island,  Texas,  Utah,  Virginia,  and  Washington  the 
diploma  confers  no  right  to  practise  and  has  no  legal  value, 
except,  in  some  cases,  to  give  its  possessor  standing  before  an 
exaraining-board.  The  right  to  practise  in  each  of  these 
seventeen  States  is  determined  by  examinations  before  boards 
of  examiners  enacted  by  law. 

Second  class.  In  California,  Colorado,  Connecticut,  Dela- 
ware, Illinois,  Iowa,  Kentucky,  Louisiana,  Missouri,  Mon- 
tana, Nebraska,  New  Mexico,  Oklahoma,  Oregon,  Tennessee, 
Vermont,  and  West  Virginia  the  diploma  is  subject  to  the 
supervision  of  some  designated  body  vested  by  law  with  au- 
thority to  determine  its  validity  as  evidence  of  its  possessor's 
qualification  for  the  practice  of  medicine.  Failing  the  pos- 
session of  such  recognized  diplomas,  the  right  to  practise  may 
be  acquired  by  passing  a  satisfactory  examination. 

Third  class.   In  Arizona,  Georgia,  Idaho,  Indiana,  Kan- 

23 


354  ESSAYS  AND  ADDRESSES. 

sas,  Michigan,  Nevada,  Ohio,'  South  Carolina,  Wisconsin, 
and  Wyoming  the  presentation  of  any  kind  of  a  diploma, 
provided  only  that  it  be  from  a  "  chartered  "  medical  insti- 
tution, is  sufficient  in  law  for  county  clerks,  clerks  of  courts, 
registrars  of  deeds,  and  similarly  qualified  judges  of  medical 
fitness  to  admit  to  practice. — Journal  of  the  American  Medical 
Association,  March  10,  1894. 

It  thus  appears  that  in  the  first  class  the  restrictive  legis- 
lation is  complete  and  sufficient  to  protect  the  communities 
in  the  respective  States  from  ignorance  and  charlatanry.  In 
the  second  class,  with  competent  and  efficient  boards  of  ex- 
aminers, the  protection  can  only  be  partially  satisfactory,  but 
is  far  preferable  to  the  loose  and  ill-constructed  laws  in 
operation  in  the  third  class  of  States. 

With  the  view  of  renewing  the  negotiations  to  effect  some 
agreement  with  the  Homoeopathic  Medical  Society,  I  wrote, 
October  21st,  to  Dr.  J.  B.  Gregg  Custis,  to  which  his  reply 
is  as  follows  : 

"  November  1, 1895. 

' '  Dear  De..  Busey  :  Your  esteemed  favor  of  October 
21st  duly  received. 

^^  Nothing  would  give  the  Homoeopathic  Medical  Society 

1  An  unanswered  letter  : 

H.  N.  TEETERS,  D.D.S.,  M.D.,  H.  N.  TEETERS,  D.D.S.,  M.D., 

Specialist  Deuggist. 

in  Fine  Gold  Mallet  Fillings,  Gold  Crowns  Squibs  &  Powers  and  Weightman's  Goods 

and  Bridge  Work.  Always  on  Hand. 

Teeth  Extracted  Without  Pain.  Prescriptions  Carefully  Compounded. 

And  New  Ones  Inserted  in  Five  Minutes.  No.  153  Main  Street. 

Office  151  Main  Street.  Open  Day  and  Night. 
Open  Day  and  Night. 

MONONGAHELA,  PA.,  NoV  1st  1895 

Sec  District  Medicle  Society, 

Washington  D  C 
Dear  Dr 

What  is  the  Fee  for  Certificate  of  Medicle  Society  to  Practice  Medicine  in  D  C  Can 
I  go  before  a  Notary  Public  here  and  make  Affidavit  as  to  Qualification  and  forward 
to  you  with  Fee  and  secure  the  Certificate  Without  being  Present 

I  am  at  Present  Practicing  Medicine  and  Dentistry  in  Steubenville  Ohio  and  Am 
thinking  of  Moving  to  D  C 
Please  let  Me  hear  from  You  as  soon  as  Possible. 
Yours  Respt 

H.  N.  TEETERS  M  D,  D  D  S 

417  Dock  Street 
Steubenville  Ohio 


ESS  A  YS  A  NI)  A  I)  I)  11 ESSKS.  35,0 

greater  pleasure  tliaii  tliul  it  h1i<miI(I  he  al>le  to  u;;ree  with 
the  Soeiety  you  so  ahly  represent  on  a  hill  to  be  presented 
to  CoHi^re.SH,  and  onewhidi  tlie  two  associations  fould  makf;  a 
common  eause.  We  had  intended  to  introduce  a  hill  similar 
to  that  introduced  by  Senator  Teller  in  the  last  Congress, 
known  as  Senate  bill.  No.  2fi45,  a  copy  of  which  I  enclose. 

"  You  will  remember  that  after  some  consultation,  and  in 
deference  to  your  wishes,  we  accepted  several  amendments  to 
that  bill,  which  we  will  gladly  embody  in  the  new  one.  The 
amendments  are  as  follows  : 

''1.  After  the  word  'Columbia,'  in  section  1,  line  6, 
strike  out  the  paragraph  beginning  '  The  members  of  one 
board/  down  to  the  word  '  The,'  in  line  9,  same  section,  and 
insert  in  lieu  thereof  the  words  '  one  board  shall  be  composed 
of  five  piiysicians  in  good  standing,  adherents  of  the  "  regular" 
school  of  practice.' 

''  We  would  much  prefer  to  have  the  five  selected  from 
members  of  the  Medical  Soeiety.  If  it  is  possible,  and  we 
are  not  misinformed  as  to  the  standing  of  the  Medical  Asso- 
ciation of  the  District  of  Columbia,  we  would  suggest  a  sub- 
stitute for  the  above  amendment  :  One  board  shall  be  com- 
posed of  five  physicians  in  good  standing,  members  of  the 
Medical  Association  of  the  District  of  Columbia.  I  believe 
that  this  removes  the  objection  made  by  graduates  of  Harvard 
University,  as  they  are  eligible  for  membership  in  that  body. 

^'2.  After  the  word  licenses,'  section  4,  line  5,  insert  '  no 
questions  except  such  as  have  been  approved  by  a  majority 
of  said  committee  shall  be  used  in  any  examination.' 

'^I  will  state  here  that  we  must  insist  upon  equal  repre- 
sentation on  the  Committee  on  Examinations.  You  will 
remember  that  the  Commissioners,  at  the  suggestion  of  the 
health  officer,  proposed  that  a  committee  be  composed  of  five 
members,  two  of  whom  should  not  be  members  of  the  boards, 
and  that  we  objected,  which  objection  we  will  have  to  main- 
tain, unless  it  be  stated  that  the  remaining  members  be  gov- 
ernment officials  and  not  physicians. 


356  JESSAYS  AND  ABBBESSES. 

"  3.  Section  6,  line  22,  after  the  word  '  Columbia,'  insert 
'  when  any  set  of  examination-papers  has  been  finally  acted 
upon,  it  shall  be  filed  in  the  health  office  of  the  District  of 
Columbia,  subject  to  the  inspection  of  the  Examining  Com- 
mittee or  any  member  thereof. ' 

''Section  7,  line  9,  strike  out  all  after  the  word  'turpi- 
tude,' down  to  the  word  '  In,'  line  10,  same  section. 

"  The  last  two  amendments  were  made,  I  believe,  to  meet 
the  objections  of  some  of  the  District  Committee. 

"  Our  committee  will  be  glad  to  receive  and  give  careful 
attention  to  any  suggestions  that  may  please  you  to  make. 

' '  Hoping  that  for  the  good  of  the  city  and  welfare  of  its 
citizens  our  efforts  before  Congress  may  meet  with  success, 
I  am,  Very  truly  yours, 

"J.  B.  Gbegg  Custis, 

"  Chairman." 

"S.  C.  BusEY,  M.D., 

"  President  Medical  Society  of  ttie  District  of  Columbia." 

The  committee  met  November  7th,  and,  after  consideration 
of  the  subject,  unanimously  agreed  to  present  to  Congress  the 
bill  S.  325,  entitled  "A  bill  to  regulate  the  practice  of  medi- 
cine in  the  District  of  Columbia,"  a  copy  of  which  was 
mailed  to  Dr.  Custis  November  28,  1895,  to  which  his 
reply  is  as  follows  : 

"Washington,  D.  C,  November  30, 1895. 

"S.  C.  BusEY,  M.D., 

"Chairman  Committee  of  Medical  Legislation,  Medical  Society  of  the 
District  of  Columbia. 

"  Dear  Sir  :  It  gives  me  great  pleasure  to  announce  the 
approval  of  our  committee  to  the  bill  as  forwarded  to  me 
this  day  by  Dr.  Woodward,  and  to  pledge  our  support  of 
the  same  without  alteration  or  amendment. 

"  Expressing  the  hope  that  our  united  efforts  may  secure 
its  early  enactment  as  a  law,  I  am 

"  Yours  most  respectfully, 

"J.  B.  Gregg  Custis, 

"  Chairman  of  Committee." 


ESfiA  YS  A  Nf)  A  DDRKSHKS.  .'{fjT 

I  am,  tlicrcfore,  auiliorizcd  to  uiinouncc  to  you  u  .satisfac- 
tory conclusion  of  these  negotiations,  and  the  very  favorable 
prospects  of  adequate  legislation  in  the  near  futun;  that  will, 
at  least  in  some  measure,  mitigate;  the  evils  of  which  we  com- 
plain and  offer  protection  to  this  community  from  the  influx 
of  charlatans  and  impostors,  and,  moreover,  the  j)ros|)ective 
advance  in  the  higher  education  of  medical  men  (see  Senate 
bill  325,  first  session,  54th  Congress). 

This  bill  has  been  approved  by  the  Commissioners  of  the 
District  of  Columbia  and  forwaided  to  the  Senate  with  their 
recommendation. 

Society  Publication  of  its  Transactions. 

The  first  attempt  of  this  Society  to  publish  its  transactions 
was  in  the  form  of  a  quarterly  bulletin  of  twenty-four  pages 
in  accordance  with  the  following  schedule  : 

"At  a  regular  meeting  of  the  Society,  held  November  12, 
1873,  Dr.  S.  C.  Busey  offered  the  following  resolution,  which 
was  adopted  : 

"  'Resolved,  That  the  Committee  on  Essays  be  and  are 
hereby  requested  to  inquire  into  the  expediency  and  expense 
of  publishing  a  bulletin  of  the  debates  before  the  Society,  and 
to  report  in  writing,  with  such  recommendation  as  may  be 
deemed  proper.'  " 

November  19,  1873: 

"  The  Committee  on  Essays,  which  was  requested  by  a 
resolution  passed  at  the  last  meeting  to  inquire  into  the  ex- 
pediency and  expense  of  publishing  a  bulletin  of  the  debates 
before  the  Society,  etc.,  beg  to  make  the  following  report: 

"  1.  The  committee  believe  it  would  be  eminently  proper 
and  expedient  for  the  Society  to  publish  reports  of  its  pro- 
ceedings. Such  a  course,  they  conceive,  would  enhance  the 
usefulness  of  the  Society,  stimulate  its  members  to  present 
better  papers  and  essays,  and  tend  to  improve  the  scientific 
character  of  its  debates. 


358  ESSAYS  AND  ADDRESSES. 

''  2.  The  committee  recommend  that  the  material  selected 
for  publication  shall  be  coofined  to  the  followiug  several 
heads : 

''  (rt)  Original  theories  or  synopsis  of  papers  containing 
such  theories. 

"  (6)  Original  modes  of  practice. 

''  (c)  Cases  testing  modes  of  practice  still  sub  judiee. 

"  [d)  Cases  deserving  of  record  from  their  being  curious  or 
rare. 

"  (e)  New  facts,  experiments,  or  discoveries  appertaining 
to  medicine  and  its  allied  sciences. 

"if)  Such  parts  of  debates  as  it  may  be  deemed  by  this 
committee  would,  if  published,  be  of  general  interest  to  the 
profession  at  large  or  tend  to  promote  the  advancement  of 
medical  science. 

"  3.  The  committee  recommend  that  the  published  report 
or  bulletin  be  issued  quarterly,  and  that  it  shall  bear  on  its 
title-page  the  words  '  Transactions  of  the  Medical  Society  of 
the  District  of  Columbia.' 

"  4.  The  committee,  on  inquiry,  find  the  expense  of  pub- 
lication in  pamphlet-form,  octavo  page  of  48  lines,  solid  print, 
and  without  cover,  will  be  for  12  pages  (500  copies)  twenty- 
five  dollars  per  quarter  ;  for  twenty-four  pages  (500  copies) 
fifty  dollars  per  quarter  ;  or,  respectively,  one  hundred  or 
two  hundred  dollars  per  year. 

"  5.  The  committee  recommend  that  a  pamphlet  of  twenty- 
four  pages,  the  number  of  copies  500,  be  printed  quarterly, 
and  that  an  appropriation  of  fifty  dollars  per  quarter  from 
the  treasury  of  the  Society  be  applied  to  the  payment  of  the 
expense  incurred. 

"  B.  Thompson,  M.D., 
^^A.  F.  A.  King,  M.D., 
^'Chas.  E.  Hagner,  M.D., 

"Committee." 

The  issue  of  these  quarterly  bulletins  commenced  in  April, 
1874,  and    ceased   in  July,    1878,   with  the  completion   of 


ESSAYS  AN J>  Ann/U'JSSh'S.  359 

Volume  IV.  of  llio  Transactionx  of  the  Medicxil  Society  of 
the  District  of  Cotumhia,.  Subscfjiiciitly  itn  iirran^'(rmcMt  was 
made  with  the  Mixryland  Medical  Journal,  and  lat/*r  with 
the  Journal  of  the  American  Medical  AHHOciafion,  for  the 
publication  of  its  transactions,  which  provwl  so  unsatisfac- 
tory it  was  discontinued.  Several  years  a^o  an  a^frccmcnt 
was  perfected  with  the  National  3fed leal  Reviev  for  tlie  ]>ul> 
lication  of  an  abstract  of  the  discussions,  wliicli  continues  in 
operation  to  date. 

It  is  not  my  purpose  to  interfere  with  the  existing  arrange- 
ment, beyond  the  statement  that  it  is  inadequate  and  unsatis- 
factory. This  Society  is  quite  up  to  the  highest  standard  of 
similar  organizations  in  atteudance,  capacity,  and  activity, 
but  lacks  means  and  opportunity  to  establish  its  reputation 
before  the  profession  at  large.  The  publication  of  individual 
coutributions  in  medical  journals,  selected  by  personal  prefer- 
ence, with  the  foot-note  accrediting  its  presentation  to  this 
Society,  is  not  objectionable,  and  tends  to  extend  the  reputa- 
tion of  the  author,  but  adds  but  little,  if  any,  to  the  standing 
of  this  Society.  This  privilege  should  not  be  abridged  or 
discontinued.  The  ownership  of  the  essay,  and  right  of  pub- 
lication when  and  in  such  manner  as  he  pleases,  should  be- 
long to  the  author.  The  Society  should  not  hold  the  exclu- 
sive right  of  priority  of  publication  of  the  essays  read  before 
it  without  great  injustice  to  the  authors.  The  delay  in  the 
preparation  and  publication  of  a  society  bulletin  or  volume 
of  transactions  would  prove  a  serious  obstacle  to  the  presenta- 
tion of  papers  of  immediate,  original,  and  scientific  value,  and 
necessarily  exclude  such  from  the  current  proceedings. 

I  disclaim  any  purpose  to  interfere  with  or  to  restrict  the 
rights  and  privileges  of  authors,  and  am  equally  averse  to  the 
erection  of  any  hindrance  to  the  attainment  and  promotion 
of  individual  reputations.  I  do,  however,  hold  and  seek  to 
enforce  the  conclusion  that  the  higher  and  more  widely  dis- 
seminated the  scientific  character  and  standing  of  this  Society, 
the  more  accentuated  and  distinctive  its  membership.     The 


360  ESSA  YS  AND  ADDRESSES. 

world  of  science  recognizes  membership  in  some  one  or  more 
of  many  scientific  organizations  as  the  badge  of  honor,  ca- 
pacity, and  achievement.  Such  I  would  make  membership  of 
this  Society.  The  graduates  of  the  University  of  Pennsyl- 
vania passed,  on  first  examinations  during  the  past  ten  years, 
without  a  single  failure,  the  Medical  Examining  Board  of 
Virginia.  Who,  then,  will  deny  to  such  graduates  the  honor 
of  the  affix  of  the  university  to  their  degrees  of  M.D.? 
This  is  only  one,  but  a  significant  citation.  Many  others 
might  be  attested.  The  qualification  and  capacity  of  her 
graduates  were  proved,  but  the  individual  success  was  no 
higher  than  the  honor  of  every  other  successful  applicant  on 
first  examination.  The  uniform  success  of  all  was,  however, 
a  distinction  of  which  their  alma  mater  can  boast.  So,  like- 
wise, may  each  one  of  a  score  of  essayists  successfully  pass 
the  crucible  of  current  criticism  and  receive  the  commenda- 
tion of  his  peers;  but  it  is  the  publication  of  the  essays  in 
some  concrete  and  permanent  form  that  will  establish  and 
maintain  the  reputation  of  the  Society  which  honors  the  au- 
thors with  membership.  I  concede  the  high  distinction  to 
which  many  of  you  have  attained,  and  bear  testimony  to  the 
merit  of  your  contributions  to  medical  literature  and  science, 
but  I  also  plead  for  that  reciprocal  impetus  to  higher  distinc- 
tion which  can  only  be  developed  by  the  combination  of  indi- 
vidual and  organized  effort. 

During  the  two  years  past  of  my  presidency  there  have 
been  read  before  this  Society  many  papers  that  would  have 
added  to  the  reputation  of  any  medical  society  in  this  coun- 
try, but  their  permanent  value,  except  to  the  few,  has  been 
frittered  away  in  the  mass  of  current  journal  literature. 
What  has  established  the  world-wide  and  enduring  reputa- 
tions of  the  London  Obstetrical  Society,  the  American  Gyne- 
cological Society,  the  Association  of  American  Physicians, 
and  many  other  equally  renowned  societies  ?  The  student, 
scholar,  and  investigator  seeks  facts,  not  men.  He  does  not 
go  to  the  biographies  and  autobiographical  sketches  of  the 


ESS  A  YS  A  NI>  A  I)  DRESSES.  .'ifj  ] 

cyclopoedia.s  of  (lI.stinguiHlied  pliysiciana,  l)iil  fiiniH  \\\c  {)age« 
of  the  voliim(!  of  transactions  in  search  of  \\u'.  inforniation  arifi 
instruction  desired. 

In  this  conn(!ction  J  rc(!all  your  attention  to  the  essays  read 
and  the  discussions  thereon  in  this  Society  in  the  past  two 
years  on  ''Tuberculosis,  ''Typhoid  Fevor,"  "Hydropho- 
bia," and  "  I)iphth(!ria,"  which  are  far  in  advance  of  any 
similar  consideration  of  those  subjects  by  any  medical  society 
in  this  country,  and  yet  their  value  as  society  investigations 
has  been  so  completely  fluttered  away  that  the  meml)ers  can- 
not revive  their  recollections  by  referring  to  their  publication. 

Some,  perhaps  many  of  you,  will  think  that  I  have  under- 
taken an  enterprise  more  fanciful  thau  practical.  My  reliance 
upon  ray  knowledge  of  human  nature,  which  I  have  gleanefl 
from  personal  association  with  and  observation  of  medical 
men,  has  brought  me  to  the  conclusion  that  a  majority  of 
men  of  reputation  seek  to  record  the  evidence  of  their  success 
and  achievements  in  some  permanent  form.  And  even  those 
who  pursue  the  profession  for  a  mere  livelihood  or  gain  are 
not  without  hope  that  their  better  qualities  and  good  deeds 
may  not  be  hopelessly  forgotten. 

I  believ^e,  with  the  committee  of  1873,  that  a  society  pub- 
lication, preferably  an  annual  volume  of  transactions,  with- 
out infringement  or  abridgment  of  the  private  rights  and 
ownership  of  authors,  would  "  enhance  the  usefulness  of  the 
Society,  stimulate  its  members  to  present  better  papers  and 
essays,  and  tend  to  improve  the  scientific  character  of  its  de- 
bates." And,  moreover,  that  the  continuous  publication  to 
date  of  the  bulletin  of  1873-'78  would  have  added  immeas- 
urably to  the  standing  of  this  Society  in  the  profession-at- 
large. 

The  single  objection  of  expense,  I  hope,  will  not  be  worthy 
of  consideration  by  a  society  of  two  hundred  and  seventy- 
seven  active  members,  that  adds  annually  to  its  surplus  on 
an  assessment  of  three  dollars  per  capita. 

In  conclusion,  I  avail  myself  of  this  occasion  to  record,  in 


362  ESSA  YS  AND  ADDRESSES. 

this  formal  manner,  the  expression  of  gratitude  to  this  Society 
for  the  sympathy  and  good-wishes  set  forth  in  the  resolutions 
of  April  10,  1895.  This  memorial,  together  with  the  indi- 
vidual testimonials  of  sympathy  from  one  hundred  and  more 
members  of  this  Society,  has  been  filed  among  the  archives 
of  my  professional  life,  in  grateful  remembrance  of  that  good- 
will and  prompt  significance  of  those  qualities  of  Christian 
sympathy  which  move  the  great  brotherhood  of  medicine  to 
the  noblest  deeds  of  benevolence  and  tender  kindliness  of 
heart.  If  I  could  measure  the  pleasure  and  consolation  those 
outpourings  of  "the  milk  of  human  kindness  "  brought  to 
the  victim  of  inexcusable  and  culpable  negligence  during 
the  hours  and  days  of  acute  suffering,  my  words  would  empha- 
size that  sublime  ideal  of  gratitude  which  can  be  felt  but  can- 
not be  spoken. 

From  others,  many  times  greater  in  number,  from  among 
the  great  mass  of  good  people,  came  also  tokens  iu  various 
forms  of  manifest  sympathy,  in  evidence  of  the  fact  that 
humanity  grows  richer  in  the  ennobling  qualities  of  the 
mind  and  heart  with  the  progress  of  Christianity  and  civili- 
zation. 

Then,  too,  this  Society  should  invoke  the  continued  bless- 
ing of  Providence,  that  has  restored,  with  but  one  death 
during  the  year,  so  many  members  to  health  and  usefulness 
who  have  been  afflicted  with  sickness  well-nigh  to  the  utmost 
limit  of  human  endurance. 


ESSAYS  AND  ADDIIESSES.  :if;:j 


BILL   KELATLNC;    TO    TLSTTMONY    OF 
PHYSICIANS. 

KEPORT   OP  ('OMMITTEE   ON   lULL  ISOLATING   TO   TESTIMONY 

OF  I'lrvsrciANS  in  tiih  (X)Uiit.s  f)K  Tin-:  dihtiuct 

OF   COLD  MIMA,    1  «lj6. 

l.>15  IST..N.  W., 
Wa.sminoton  City,  D.  C,  p-ebruary,  1896. 

Hon.  John  W.  Ross, 

President  of  the  Board  of  Commissioners,  D.  C. 

Sm  :  Tlie  bill  H.  R.  No.  "2647,  entitled  ''A  bill  relating 
to  the  testimony  of  physicians  in  the  Courts  of  the  District  of 
Columbia,"  has  been  drafted  and  presented  to  Congress  by 
direction  of  the  Medical  Society  of  the  District  of  Columbia. 
It  is  modelled  after  the  law  of  the  State  of  New  York,  and 
is  substantially  the  same  as  similar  laws  in  force  in  twenty 
States  and  one  Territory  of  this  country,  the  first  of  which 
was  enacted  by  the  State  of  Oregon  in  1872,  and  the  latest  in 
1887  by  the  States  of  Indiana,  Wyoming,  Montana,  and  Idaho. 

The  following  list  includes  the  States,  with  the  year,  page, 
and  section  of  the  statute-book  in  which  the  law  is  to  be 
found : 


states. 

Year. 

Page. 

Sec. 

Arliansas, 

Slat. 

.    1883 

625 

2862 

California, 

Code  C.  P.     . 

.    1885 

1881 

Colorado, 

Gen.  Stats.     . 

.    1883 

1062 

4 

Dakota, 

Comp.  Laws  . 

.    1887 

910 

5313 

Idaho, 

Rev.  Stat. 

.    1887 

679 

Indiana, 

Rev.  Stat. 

.    1887 

679 

497 

Iowa, 

Rev.  Code      . 

.    1884 

860 

Kansas, 

Comp.  Law    . 

.    1885 

645 

323 

Michigan, 

Gen.  Stat..     . 

.    1882 

1889 

7516  and  86 

Minnesota, 

Gen.  Stat. 

.    1881 

792 

10 

Missouri, 

Rev.  Stat.      . 

.    1879 

690 

4017 

Montana, 

Comp.  Stat.    . 

.    1887 

230 

Civ.  Cod.  650 

Nevada, 

Gen.  Stat.  .    . 

.     1885 

833 

3406-84 

New  York, 

Code  C.  P.      . 

(4  Rev. 

Stat.  164) 

834 

Ohio, 

Rev.  Stat. 

.     1884 

1096 

5241 

Oregon, 

Gen.  Law 

.     1872 

251 

Utah, 

Comp.  Laws  . 

.     1876 

506 

Washington, 

Code 

.    1881 

102 

392 

Wisconsin , 

Rev.  Stat.      . 

.    1878 

992 

4075 

Wyoming, 

Rev.  Stat.      . 

.    1887 

590 

2589 

Oklahoma  Territory. 


364  ESSAYS  AND  ADDRESSES. 

The  opposition  to  the  enactment  of  this  bill  is  set  forth  in 
the  protest  of  six  justices  of  the  Supreme  Court  of  the  Dis- 
trict of  Columbia,  now  on  file  with  the  Board  of  Commis- 
sioners of  the  District  of  Columbia,  to  which  I  am  directed 
by  the  Committee  of  the  Medical  Society  of  the  District  of 
Columbia  to  make  reply  as  follows  : 

The  medical  profession  in  this  District  holds  in  high  esteem 
the  justices  of  the  Supreme  Court  of  the  District  of  Colum- 
bia, as  well  for  their  learning  and  judicial  ability  as  for  their 
personal  standing  and  integrity  ;  but  it  is  surprised  that  they 
should  unite  in  a  formal  protest  against  the  enactment  of  this 
bill,  which  has  for  its  object  the  extension  to  the  citizen  of 
the  liberty  of  privileged  communications,  and  for  his  protec- 
tion in  the  enjoyment  of  the  right  of  unrestricted  and  confiden- 
tial confession  to  his  physician,  now  denied  him  by  the  com- 
mon law  in  force  in  this  District  and  enforced  by  the  said  six 
justices  of  the  Supreme  Court  of  the  District  of  Columbia.  It 
is  quite  reasonable  to  suppose  there  are  in  either  House  of 
Congress  many  men  who,  for  the  time  being,  are  discreet 
legislators  and  fully  qualified  to  determine  the  utility  and 
wisdom  of  such  laws,  to  whom  the  Medical  Society  will  ap- 
peal with  the  hope  of  securing  the  passage  of  H.  R.  bill  No. 
2647,  the  opposition  of  the  justices  of  said  court  to  the  con- 
trary notwithstanding,  and  it  will  continue  to  prosecute  its 
purpose  with  unabated  zeal  until  success  shall  crown  its  efforts. 

It  is  not  known  to  the  Medical  Society,  nor  to  any  member 
thereof,  that  any  organized  opposition,  either  judicial  or  popu- 
lar, has  been  made  to  the  enforcement  of  such  laws  in  any  of 
the  States  in  which  such  statutes  exist,  or  that  any  effort  has 
been  made  to  repeal  them,  or  that  any  conflict  exists  in  re- 
gard to  their  utility  and  justice.  It  must,  therefore,  at  least 
be  inferred  that  the  wisdom  of  such  statute  protection  of  physi- 
cians from  enforced  disclosure  of  the  confidential  communica- 
tions of  patients  has  been  established,  and  it  remains  only  to 
extend  such  protection  to  less  favored  communities. 

The  bill  is  intended  to  protect  physicians  from  the  com- 


/'JSSA  YS  AND  AhfUtESSJ'JS.  3^5 

pulsory  (HH(!l()Htn'(!  of  iiirorniiiiioii  ;i('i(iiirc(l  in  ;i  j)rof(;»HionaI 
capaciity,  and  vvliicli  may  Ix;  iKiccsHury  to  ciiiiWh!  tln'in  to  man- 
age cases  oC  siekness  with  iiit(!lligf;iif(!  and  sucf-eHS.  It  fre- 
quently occurs  that  patients  will  conceal  importatit,  and  some- 
times absohitcily  necessary  information,  and  oefasionally  will 
deny  the  existence  or  })revious  occurrence  of  certain  circum- 
stances or  conditions  alleged  by  the  physician,  until  admis- 
sion or  confession  is  extorted  hy  some  statements  of  tlie  ])hy8i- 
eian  that  longer  concealment  or  denial  would  prove  dangerous 
and  perhaps  fatal.  It  is  a  recognized  principle  of  law  that  a 
witness  cannot  be  forced  to  criminate  himself.  Surely  infor- 
mation extorted  by  a  physician,  or  communicated  to  liim  in 
the  confidence  of  a  confiding  patient,  should  be  equally  in- 
violable as  information  known  only  to  the  witness  himself. 
If  a  witness  cannot  be  compelled  to  criminate  himself  directly 
by  confession  in  open  court,  is  it  not  gross  injustice  to  compel 
him  to  criminate  himself  indirectly  by  the  compulsory  dis- 
closure of  his  confession  or  confidential  communication  to  his 
physician  made  under  duress,  fright,  or  emotional  impulse  ? 

If  a  man  unwillingly  confesses  some  circumstance,  iucident, 
or  vice  of  his  life  to  a  physician,  to  enable  that  physician  to 
treat  an  existing  ailment  with  intelligence,  is  it  more  than 
exact  justice  to  grant  him  the  right  of  refusing  permission  to 
such  physician  to  disclose  in  open  court  such  confidential 
communication  ?  The  bill  is  intended  to  protect  the  patient 
from  such  indirect  and  involuntary  crimination  of  himself, 
and  compulsory  disclosure  of  a  secret  confided  to  his  friend 
and  physician. 

The  second  paragraph  of  the  protest  of  the  six  justices  sets 
forth  three  averments  in  opposition  to  this  bill : 

1.  "  New  York  is  the  only  Atlantic  Coast  State"  that 
has  adopted  sucli  a  law. 

2.  ''Arkansas  is  the  sole  Southern  State"  in  which  such 
a  statute  exists. 

3.  "  The  legislation  is  comparatively  receut,  and  of  the 
States   adopting   it  all   are   quite   young   except   those  just 


366  ESSAYS  AND  ADDRESSES. 

mentioned  "  (New  York  and  Arkansas),  and  California,  In- 
diana, Iowa,  Kansas,  Michigan,  Minnesota,  Missouri,  Ohio, 
and  Wisconsin. 

The  third  avermeut  carries  with  it  the  emphatic  contra- 
diction of  the  averment  of  recency,  because  of  the  admission 
that  it  is  inapplicable  to  eleven  of  the  twenty  States  in  which 
such  statutes  exist.  If  the  averment  of  recency  was  true, 
how  would  such  fact  disprove  or  lessen  the  wisdom  aud  jus- 
tice of  such  laws  ?  Ou  the  contrary,  it  would  seem  to  estab- 
lish the  equity  of  such  legislation,  because  in  evidence  of  the 
progress  of  a  higher  civilization  and  broader  conception  of 
private  rights  and  privileges.  The  progress  of  civilization 
during  the  past  twenty-four  years  (the  first  law  dates  back 
to  1872)  has  not  been  more  clearly  shown  than  in  the  many 
recent  statutory  modifications  of  and  exemptions  from  legal 
traditions  than  by  such  legislation  in  the  States  named,  which 
has  exempted  twenty-seven  (census  of  1890)  millions  of  the 
citizens  of  this  country  from  such  compulsory  disclosures. 

The  citation  of  one  Atlantic  coast  and  one  Southern  State 
is  even  more  fallacious,  and  partakes  of  the  nature  of  a  deri- 
sive appeal  to  geographical,  sectional,  or  local  prejudices. 
New  York  is  the  largest,  most  populous,  and  wealthiest  of 
the  original  thirteen  States.  Why,  then,  may  not  her  statute 
of  exemption  be  accepted  as  testimony  in  support  of  the  jus- 
tice of  such  legislation,  all  the  more  strongly  so  because,  as 
yet,  there  has  been  neither  judicial  nor  popular  remonstrance 
against  such  statutory  protection  of  physicians  from  the  com- 
pulsory disclosure  of  the  confidential  communications  of  her 
sick  citizens  ?  And,  surely,  Arkansas  is  old  enough  and  her 
citizens  are  sufficiently  advanced  in  civilization  to  know  how 
best  to  protect  her  citizens  in  their  private  rights  and  privi- 
leges. So  far,  then,  these  two  States  may  be  cited  as  exem- 
plars worthy  of  the  emidation  of  other  sister  States  still  lag- 
ging in  the  tradition  of  the  common  law  transmitted  to  us 
from  English  descent. 

The  Medical  Society  of  the  District  of  Columbia,  as  does 


h'S.SA  VS  AND  Ah  DRESSES.  '.)(]'! 

the  medical  profe.sHion-at-largc,  admits  (see  third  paragraph  of 
protest)  th(!  justice  of  the  exemption  of  legal  aflvis(;r.s  from 
enfor(H:d  diwiioKurc  of  the  secnitH  of  their  clients;  hut  it  can- 
not be  admitted  that  such  confidential  communir^ation.s  are 
more  sacred  than  the  conndenccs  of  sick  people.  T^fgal  ad- 
visers and  attorneys  are  for  tlie  most  part  concerned  with  liti- 
gants, and  their  confidential  informatif)n  relates  mainly  to 
business  matters  and  property  values.  The  confidences  of 
the  physician  refer  most  especially,  and  in  most  instance.s 
exclusively,  to  personal  conditions,  character,  temperament, 
idiosyncrasies,  vices,  indiscretions  of  life,  family  history,  in- 
herited predispositions  and  diseases,  and  avoidable  and  un- 
avoidable afflictions,  social  as  well  as  pathological,  and  all 
this  in  the  interest  of  health,  longevity,  and  life.  If  these 
two  widely  different  classes  of  confidences  could  be  measured 
by  any  common  or  uniform  standard,  those  of  the  physician 
would  rise  far  above  those  of  the  attorney  on  the  scale  of  in- 
violability. 

It  is  stated  in  the  same  paragraph  that  if  the  privilege  was 
not  '^  extended  to  communications  between  legal  adviser  and 
client,"  "  no  man  would  dare  consult  a  professional  ads'iser 
with  a  view  to  his  defence  or  the  enforcement  of  his  rights." 
The  predicate  and  postulate  are  both  conceded,  and  it  is 
equally  true  that  ''no  man  would  dare  consult"  his  medical 
adviser  with  a  view  to  the  treatment  and  cure  of  disease  if 
he  knew  that  his  confidential  communications  and  confessions 
would  be  disclosed  in  open  court.  ^'  The  privilege  extended 
to  communications  between  legal  advisers  and  client  at  com- 
mon law  "  is  based  upon  public  policy,  but  that  fact  cannot 
justify  the  limitation  of  the  privilege  exclusively  to  the  legal 
profession,  nor  is  it  believed  that  popular  judgment,  always 
the  safest  depositary  of  power,  will  sustain  such  contention. 

Under  the  common  law  the  physician  cannot  protect  him- 
self from  compulsory  disclosure  of  confidential  communica- 
tions, nor  can  the  common  law  be  amended  ;  relief  can,  there- 
fore, only  be  obtained  by  statute  law  enacted  by  the  Legisla- 


368  ESSAYS  AND  ADDRESSES. 

ture.  The  patient  should  be  protected  in  the  unreserved  and 
fearless  statement  of  his  ailment  and  its  cause.  Suppose,  for 
instance,  an  erring  man  by  a  candid  confession  aided  his 
physician  in  the  diagnosis  of  syphilis  contracted  by  illicit 
intercourse  and  is  treated  to  his  own  advantage  and  to  the 
protection  of  his  wife  and  unborn  children.  If  he  knew  his 
medical  attendant  could  be  compelled  to  convict  him  of  adul- 
tery, he  would  hesitate  to  make  such  confession,  to  his  destruc- 
tion and  the  ruin  of  his  family. 

According  to  the  census  of  1890,  twenty-seven  millions 
four  hundred  and  seventy-two  thousand  and  two  hundred  and 
ninety-six  citizens  of  this  country  have  been  exempted  by  State 
legislation  from  such  compulsory  disclosures  as  are  set  forth 
in  the  bills  H.  of  R.  No.  2647  and  Senate  981.  These  bills 
seek  to  guarantee  to  this  community  the  same  protection. 
The  original  bill  was  prepared  by  a  distinguished  attorney 
of  the  local  bar,  after  a  careful  examination  of  the  statutes 
in  the  twenty  States.  This  simple  statement  of  facts  is  a 
conclusive  answer  to  the  protest  of  the  six  justices,  and  estab- 
lishes the  wisdom  and  justice  of  such  legislation. 
I  have  the  honor  to  be 

Your  obedient  servant, 

Samuel  C.  Busey, 

President  of  the  Medical  Society  of  the 
District  of  Columbia. 


EULOGY. 


DELIVERED     BY    THE    PRESIDENT    BEFORE    THE    MEDICAL 

SOCIETY   OF    THE    DISTRICT    OF    COLUMBIA, 

OCTOBER    21,    1896. 

Gentlemen  :  It  becomes  my  duty  formally  to  announce 
to  you  the  death  of  Dr.  Joseph  Meredith  Toner,  who  died 
July  31st  at  Cresson  Springs,  Pennsylvania,  where  he  had 
gone  to  escape  the  heat  of  the  city  and  pass  his  summer 


ESS  A  YS  A  ND  A  DDR  KSSKS.  ;{ (\  9 

vacation.  A  Hiw  dayn  before  my  departiirc  from  tlir;  fity, 
late  ill  'IiiiK!  hml,  I  ealled  at  liis  rcHidcneo  to  tai<e  leave  of 
him.  After  a  brief  visit  w(!  j)arted  with  mutual  goo<l-wishe8 
for  a  pleasant  and  healthful  Kiimmer  vacation  and  return  to 
our  accustomed  places  and  duties  with  improved  health  and 
vigor.  Ya\v\\  of  us  knew  the  other's  failing  health  and  de- 
clining life,  but  hiH  genial  countenance,  cheerful  words,  and 
cordial  manner  left  no  remembrance  of  the  malady  that  wf>nld 
surely,  sooner  or  later,  jirove  fatal  to  him. 

I  do  not  recall  any  circumstance  that  freshened  my  recol- 
lection of  that  final  parting  until  the  news  of  his  voiceless 
and  painless  death  came  to  me  while  sitting  alone  by  the 
window  of  my  room  looking  out  upon  the  waves  of  the  open 
sea  as  they  came  rolling  in  and  dashed  "  high  on  a  stern  and 
rock-bound  coast,"  breaking  into  spray  that  sparkled  in  the 
gleaming  light  of  the  sotting  sun,  and  then  flowed  back  with 
the  ebb  of  the  surging  water  into  the  deep  sea.  The  moment, 
incident,  and  scene  shrouded  thought  with  sadness,  and  the 
mental  picture  of  that  last  parting  was  so  vivid  and  the  words 
of  that  last  good-by  so  pronounced  that  it  seemed  as  if  I  was 
in  his  presence,  accepting  his  valediction  ;  and  then  the  pic- 
ture broadened  out  in  expanded  outline  as  the  memory  revived 
the  recollection  of  the  incidents  of  forty  and  one  years  of  an 
acquaintance  and  companionship  now  broken  to  waste  in  the 
wreck  of  time. 

I  have  been  present  on  many  occasions  similar  to  this,  for 
many,  very  many,  members  of  this  Society  have  died  during 
the  past  forty-eight  years ;  but  it  has  not  before  fallen  to  my 
lot  to  witness  the  last  tribute  of  respect  to  the  memory  of  one 
whose  friendly  and  fraternal  companionship  I  had  enjoyed 
through  so  many  years  of  professional  life.  There  are  but 
eight  others  now  living  whose  membership  began  before  or 
is  coeval  with  his,  who  can  unite  with  me  in  giving  expres- 
siou  to  our  sorrow  at  the  loss  of  one  whom  we  honored  dur- 
ing life  and  mourn  in  death. 

Memory  is  crowded  wath  the  incidents  and  circumstances 

24 


370  ESSAYS  AND  ADDBESSES. 

of  four  decades  aud  oue  year  of  contemporaneous  association 
which  bear  testimony  to  his  courage,  fidelity,  sincerity,  and 
impartiality.  To  an  attractive  address,  courteous  demeanor, 
aud  genial  temperament  were  added  truth,  iustice,  and  mag- 
nanimity. 

It  is  not,  then,  surprising  that  those  of  us  who  knew  him 
so  many  years  should  mourn  the  death  of  a  friend  whose 
nature  and  character  were  so  richly  blessed  with  the  nobler 
qualities  of  the  human  heart  and  mind.  His  good  offices  and 
friendships  were  not  limited  to  his  lifelong  companions  and 
colaborers  of  our  profession,  but  were  as  widely  extended 
as  his  acquaintanceship  among  the  later  membership  of  this 
Society  and  in  the  commuuity-at-large.  The  positions  of 
trust  and  honor  to  which  the  profession  in  this  District  and 
in  the  country  called  him,  to  some  of  which  but  few  can  hope 
to  attain,  testify  to  his  worth  as  a  man,  his  standing  as  a 
physician,  and  his  fidelity  to  duty.  This  Society  will  hold 
his  memory  in  honored  remembrance  as  the  faithful  historian, 
who  through  years  of  painstaking  and  laborious  investigation 
collated  the  early  history  of  the  profession  in  this  District 
from  municipal  and  national  records,  newspaper  publications, 
family  reminiscences,  legend,  and  tradition.  He  verified  and 
arranged  the  data  with  such  accuracy  and  completeness  in 
an  address  delivered  September  26,  1866,  that  it  is  now  and 
always  will  be  accepted  as  the  standard  history  of  the  medi- 
cal profession  of  this  District  prior  to  1866. 

Dr.  Toner  was  neither  a  brilliant  man  nor  a  profound 
thinker,  but  he  was  eminent  and  conspicuous  as  a  patient, 
industrious,  and  honest  student.  These  qualities  he  applied 
with  assiduity  and  sincerity  to  every  purpose  he  sought  to 
accomplish.  He  was  eminently  and  acutely  truthful.  He 
had  the  courage  of  his  convictions  with  the  will  and  force 
to  maintain  them,  but  always  so  tempered  with  magnanimity 
and  foresriveness  that  the  crimination  and  bitterness  of  dis- 
agreement  and  controversy  were  either  wholly  obliterated  or 
so  mollified  that  his  friendships  were  purifiied  and  intensified. 


/';,s',sM  )',s'  AND  Ai>i)iti>:,ssics.  :>j1\ 

Plis  H<)(;i;i,l  slaiidiiiii'  and  moral  cliaractcr  won;  al)ovf!  Yc- 
proaoli.  He  stood  upon  tin;  lii^licsl,  |)lan(!  of  o\\(\\\vXU'.  and 
ethics,  but  was  novcr  an  offcnsivf!  parti.saii,  and  wi  an  cx- 
ampl(>  worthy  of  cimilation  hy  tlu;  most  punctilious  and 
circunispcct. 

His  invcstijjjationH  and  studies  n^Iated  mainly  to  nicdi'-al 
and  local  histories,  and  his  chosen  fields  of  labor  and  re- 
search referred  to  subjects  which  had  been,  for  th(;  most 
part,  entirely  neglected,  but  which  required  persistent  pur- 
suit, accurate  and  impartial  judgment,  a  well-balanced  fac- 
ulty of  analysis,  and  a  keen  and  quick  perception  of  mistake 
and  misrepresentation.  He  had  so  trained  his  mind  that 
these  qualities  constituted  the  routine  method  of  his  thought 
and  brought  to  his  aid  such  ready  and  accurate  knowledge 
that  made  him  a  living  and  walking  repository  of  a  vast 
amount  of  useful  information  sifted  down  to  its  absolute 
value  and  accuracy*  He  was  not  only  a  ''  fact  hunter,"  but 
a  hunter  of  useful  facts,  and  of  facts  hidden  in  musty  and 
forgotten  archives,  obscured  by  reminiscent  and  traditional 
misrepresentation.  He  rediscovered,  rehabilitated,  and  util- 
ized facts  for  the  common  good.  It  was  a  phenomenal  com- 
bination of  habits  of  body,  traits  of  mind,  and  trend  of 
thought  that  enabled  him  to  accomplish  so  much  that  will 
make  the  task  of  those  who  may  follow  along  the  same  lines 
of  research  and  study  easy  and  profitable. 

He  has  left  several  curious,  unique,  and  valuable  illustra- 
tions of  this  peculiar  trend  of  thought  and  mind  that  strike 
one,  at  first  glance,  as  the  work  of  one  who  was  busy  wast- 
ing time  for  something  better  to  do,  but  those  who  know  the 
value  of  such  facts  will  testify  to  his  accuracy  and  originality 
of  method  of  verification,  arrangement,  and  classification.  The 
Medical  Register,  of  the  District  of  Columbia  ;  Dictionary  of 
Elevations  and  ClimaticBegister  ;  Plan  of  Geographical  Classi- 
fication, denoting  by  symbols  the  location  of  the  counties  of 
each  State  of  the  Union,  adopted  and  now  in  use  by  the 
Postoffice  Department ;   Collections  of  Jfaps  and  Rare  Rec- 


37.2  ^SSA  YS  AND  ADDRESSES. 

ords,  which  show  the  boundary-lines  of  the  farms  as  they 
existed  when  this  city  was  laid  out,  which  accompanies  the 
work  entitled  Washington  in  Embryo  ;  and  Alphabetical  List 
of  the  Names  of  all  Persons  Residing  in  Washington  and  the 
District  of  Columbia,  June  1,  1880,  Aged  Seventy-five  Years 
and  More,  compiled  from  the  census  of  1880,  are  terse  ex- 
pressions of  mental  characteristics,  original  in  conception, 
unique  in  utility,  and  enduring  in  history  with  the  name  of 
Toner.  I  may,  with  excusable  pride,  add  to  these  citations 
his  address  to  the  Eocky  Mountain  Medical  Association,  de- 
livered June  6,  1877,  in  which,  with  most  commendable  in- 
dustry, he  classified  and  arranged  the  facts  and  data  collected 
from  the  histories  of  all  peoples  and  tribes  of  all  ages  and 
times,  from  which  he  deduced  the  following  conclusion,  set 
forth  in  the  last  two  sentences  of  the  address : 

'^  Everywhere  and  in  every  age,  among  all  tribes  and 
people,  wliether  the  most  savage  or  the  most  highly  civilized, 
may  be  traced  the  presence  of  the  physician.  He  was  ever 
deemed  a  necessity,  and  his  standing  and  influence  have 
everywhere  been  commensurate  with  his  high  and  honorable 
office,  which  won  for  him  in  the  Apostolic  age  the  appella- 
tion of  the  '  Beloved  Physician.'  " 


MEDICAL  SOCIETY  OF  THE  DISTRICT  OF 
COLUMBIA. 

THE  YEAR  1896  :  AN  EPOCH  IN  THE  HISTORY   OF   THE  MED- 
ICAL  SOCIETY    OF   THE  DISTRICT   OF    COLUMBIA. 
ANNUAL    ADDRESS     DELIVERED    BY   THE 
PRESIDENT,    DECEMBER    16,    1896. 

Gentlemen  :  The  events  that  have  occurred  during  the 
year  are  of  such  signal  and  lasting  importance  as  to  consti- 
tute an  epoch  in  the  history  of  this  Society  and  of  the  pro- 
fession in  this  District,     It  is,  therefore,  my  duty  as  it  will 


ES8A  YS  AND  A  DDIIESSES.  .'{T.'i 

1)('  my  j)l(';isui(',  lo  chronicle  iirid  arrarit^i;  tlic  factH  that  add 
stKih  nil  usual  interest  to  tiie  transactionH  of  a  single  year, 
wiili  the  h(>])e  that  ihey  may  mark  tlu;  hcginning  of  a  new  era 
iu  the  histt)ry  of  scientific  medicine  at  the  capital  of  tiie  nation. 

After  years  of  continuous  but  unsuccessful  efforts  Congress 
has  enacted  a  law  "  to  regulate  the  practice  of  medicine  and 
surgery,  to  license  physicians  and  surgeons,  and  to  punish 
persons  violating  the  provisions  thereof  in  the  District  of 
Columbia."  Mark  the  significance  of  the  words, ''  to  punish 
persons  violating  the  provisions  thereof."  The  law  may  not 
be  as  full  and  complete  in  its  protef;tivc  and  prohibitory  pro- 
visions as  some  of  us  would  desire,  but  it  oifers  the  profession 
and  community  protection  from  the  continuous  annual  influx 
of  charlatans  aud  mercenary  impostors  to  which  this  city  had 
become  exposed  because  of  proscriptive  legislation  in  forty- 
seven  States  and  Territories  of  the  country.  This  beneficent 
result  cannot,  however,  be  immediately  accomplished,  liecause 
the  former  lax  administration  of  loose  regulations  has  per- 
mitted the  registration  of  some  eminently  qualified  in  the  art 
of  charlatanry  and  fratid,  whose  vested  rights  cannot  be  alien- 
ated by  €^  post  facto  legislation,  but  must  abide  the  issue  of 
longevity  and  the  judicious  regulation  of  their  unscrupulous 
and  venal  methods.  I  will  not  trench  upon  the  privileges 
and  prerogatives  of  the  Board  of  Medical  Supervisors  by  an 
attempt  to  interpret  or  define  certain  special  provisions  of  the 
law,  but  I  am  confident  that  a  fair,  impartial,  and  vigorous 
execution  of  such  provisions,  of  which  I  have  no  doubt,  will 
so  restrict  the  methods  of  this  objectionable  class  that  we  may 
reasonably  hope  for  satisfactory  results. 

A  second  aud  no  less  important  object  of  the  law  seeks  the 
elevation  of  the  standard  of  scientific  education  and  profes- 
sional qualification — a  standard  attainable  only  by  the  gradu- 
ates of  the  highest  grade  of  medical  schools.  Nothing  less 
will  be  satisfactory  to  the  advanced  methods  of  teaching  along 
the  lines  of  scientific  and  clinical  research.  Nothing  less 
should  satisfy  the  demand  of  an   intelligent  communitv  for 


374  ESSAYS  AND  ADDBESSES. 

the  highest  skill  in  preventive  and  practical  medicine,  and 
n6thing  else  will  so  effectively  diminish  the  prevalence  and 
lessen  the  pecuniary  success  of  quackery  in  the  management 
and  treatment  of  disease. 

The  examination  by  the  Board  of  Examiners  under  the 
supervision  of  the  Board  of  Supervisors  will  compel  medical 
colleges  to  establish  a  higher  standard  for  graduation.  Com- 
plete equipment  in  knowledge,  clinical  experience,  and  train- 
ing of  successful  applicants  for  registration  will,  ipso  facto, 
conduce  to  the  greater  skill  and  proficiency  of  beginners  in 
the  practice  of  medicine.  As  a  natural  consequence  practi- 
tioners of  standing  and  reputation  must  keep  abreast  with  the 
progress  of  scientific  medicine  or  flag  in  competition  with 
their  more  skilful  and  better  educated  juniors.  Many,  per- 
haps most,  people  will  seek  those  surgeons  and  physicians 
who  offer  best  results  with  the  least  suffering.  Brilliant  suc- 
cess attaches  only  to  phenomenal  skill,  and  the  time  is  per- 
haps not  very  remote  when  success  will  be  the  measure  of 
qualification  and  attainments.  This  law  will  hasten  the  com- 
ing of  such  a  desirable  result. 

Controversies  will  arise  and  judicial  construction  will  be 
invoked.  The  law  contemplates  important  reformations, 
which  can  only  be  accomplished  by  unremitting  and  cour- 
ageous fidelity  to  the  duties  and  obligations  we  have  volun- 
tarily imposed  upon  ourselves  and  our  successors.  We  must 
popularize  its  mandatory  and  reformatory  provisions  by 
united  and  active  support  of  the  Boards  of  Examiners  and 
Supervisors  in  their  efforts  to  administer  the  trust  confided  to 
their  judgment  and  discretion. 

It  would  be  out  of  place  here  and  a  fruitless  waste  of 
time  to  narrate  to  you  the  embarrassments,  perplexities,  and 
meddlesome  outside  interference  which  beset  the  Committee 
on  Legislation^  of  this  and  of  the  Washington  Homoeopathic 

■  1  Committee  of  the  Medical  Society  of  the  District  of  Columbia :  Drs.  Samuel  C. 
Busey,  W.  W.  Johnston,  C.  H.  A.  Kleinschmidt,  Z.  T.  Sowers,  George  L.  Magruder 
George  W.  Cook,  J.  S.  McLain,  Charles  G.  Stone,  and  W.  C.  Woodward. 

Committee  of  the  Washington  Homoeopathic  Medical  Society :  Drs.  J.  B,  Gregg 
Custis,  W.  R.  King,  J.  B.  Swormsteadt,  W.  F.  Corey,  and  F.  A.  Gardner. 


ESSA  YS  A NI)  A  DDRESSES.  375 

Medical  Scnm^ty,  fo  wliose  conjoiiil  cfTort  and  harmoniouB 
co-operation  W(!  an;  indebted  for  tlif  cnaftiii'Tit  of  the  law. 
Suffi(!c  it  to  say  that  from  tiie  dale  of  the  introdnefion  of  the 
bill  agreed  upon  by  the  two  (lominittees  into  tlie  two  House* 
of  Con<j;ress  it  was  neeessary  to  wateh  and  follow  it  with  in- 
trepid vigilance  through  every  stage  of  its  progress  until  it 
was  approved  by  the  President.  In  fact,  it  practically  passed 
both  Houses  of  Congress  three  times  before  it  reached  the 
final  act  of  approval  by  the  President,  and  ef)uld  not  again 
be  interpolated  through  the  mistaken  zeal  of  some  unknown 
but  sinister  investigator.  Through  the  active  co-operation 
and  zeal  of  Senator  J.  H.  Gallinger  and  the  Hon.  .John  \V. 
Babcock  it  finally  became  a  law  in  the  form  agreed  upon  by 
the  two  Houses  of  Congress. 

Tiie  ''Act  to  provide  for  the  incorporation  and  regulation 
of  Medical  Colleges  in  the  District  of  Columbia,"  which  orig- 
inated with  the  Washington  Homoeopathic  Medical  Society, 
was  accepted  by  your  committee  as  a  measure  adding  force  to 
and  promoting  the  reforms  contemplated  by  the  jNIedical  Prac- 
tice Act.  The  necessity  and  wisdom  of  its  enactment  were  so 
apparent  that  it  met  with  but  feeble  opposition,  which  con- 
sisted of  some  vehement  declamation  in  defence  of  one  or 
more  institutions  claiming  charters  under  the  general  incor- 
poration law,  one  of  which  was  without  a  habitation,  combined 
all  the  chairs  of  a  university  in  the  person  of  one  professor, 
and  confessed  to  two  matriculates  aud  one  graduate.  But, 
whatever  may  be  the  status  of  the  institutions  caught  "  iu 
durance  vile,"  the  law  will  effectively  prohibit  the  future 
establishment  of  medical  schools  without  proper  and  ade- 
quate equipment  to  teach  medicine  at  least  according  to  some 
one  of  the  systems  legally  recognized  in  this  District.  The 
law  may  not  be  as  comprehensive  in  its  requirements  as  the 
adherents  of  the  system  of  scientific  medicine  to  which  this 
Society  belongs,  would  formulate,  yet  it  is  an  important  ad- 
vance in  the  policy  of  legal  control  and  regulation  of  medical 
schools  in  this  District,  aud  will  prevent  the  multiplication  of 


376  ESSAYS  AND  ADDRESSES. 

the  class  of  bogus  medical  schools  which  have  turned  loose 
upon  a  credulous  public  so  many  ignorant  frauds  and  venal 
charlatans.  It  is  the  beginning  of  the  end  of  mills  that 
grind  out  diplomas  at  so  much  per  square  inch  of  parchment. 

The  third  of  the  series  of  statutory  reforms,  entitled  an 
''Act  relating  to  the  testimony  of  physicians  in  the  courts  of 
the  District  of  Columbia,"  is  not  less  important  than  either 
of  the  Acts  previously  referred  to,  and  is  more  distinctly  sig- 
nificant of  the  power  and  influence  of  a  united  profession 
than  either  of  them.  The  bill  originated  with  Dr.  Z.  T. 
Sowers,  at  whose  suggestion  I  presented  it  to  this  Society  at 
the  meeting  held  March  2,  1892,  but  it  was  not  presented  to 
either  House  of  Congress  until  December,  1895,  and  then  by 
Senator  Justin  S.  Morrill,  in  the  Senate,  and  Hon.  John  W. 
Babcock,  in  the  House.  The  opposition  of  the  justices  of 
the  Supreme  Court  of  the  District  of  Columbia  was  so  for- 
midable it  seemed,  for  a  time,  impossible  to  secure  favorable 
reports  from  the  committees  on  the  District  of  Columbia  of 
the  Houses  of  Congress ;  but  finally,  due  mainly  to  the  as- 
siduous and  vigilant  efforts  of  several  members  of  your  Com- 
mittee on  Legislation,  reports  were  made  by  both  committees 
with  the  unanimous  recommendation  of  its  passage,  which 
was  done  without  dissent  in  either  branch  of  Congress.  I 
regret  to  add  that  it  became  a  law  by  constitutional  limita- 
tion, without  the  approval  of  the  President. 

This  law  has  for  its  object  the  extension  to  the  citizens  of 
this  District  of  the  liberty  of  privileged  communications  and 
their  protection  in  the  enjoyment  of  the  rights  of  unreserved 
and  confidential  confession  to  physicians,  and  is  similar  in 
import  and  effect  to  laws  in  force  in  twenty  States  and  one 
Territory  of  this  country,  and  not  unlike,  though  far  less 
comprehensive,  than  the  law  of  France.  It  is  not,  therefore, 
a  new  principle  of  law,  but  the  extension  of  a  principle,  the 
utility  and  justice  of  which  seem  to  be  established  by  twenty 
and  more  years  of  experience  in  several  of  the  States  in  which 
such  statutes  have  been  in  force. 


ESSAYS  AND  AD  PRESSES.  ;i77 

It  adds  the  force  and  fiat,  of  law  to  the  (Iccicc  of  the  iiif;di- 
cal  ])rof(!SHion,  wliicli  luiH  always  and  everywhere  throughout 
the  civilized  world  resisted  the  comj)ulHory  distrlomire  in  o[)en 
court  of  information  '^ac([uired  in  attending  a  [)atient  in  a 
professional  capacity,  and  which  was  necessary  to  enable  the 
physician  to  act  in  such  capacity."  The  inviolability  of  the 
confidences  of  the  sick-room  is  the  most  sacred  precept  of 
professional  life  It  has  come  to  iis  through  the  ages  past  as 
an  unbrolcen  rule  of  conduct,  and  all  codes  of  medical  ethic:8 
have  stigmatized  with  dishonor  the  voluntary  disclosure  of 
such  confidences.  It  is  not  then  surprising  that  we  should 
felicitate  ourselves  in  this  hour  of  triumph  and  vindication 
of  the  honor  of  our  profession,  and  legalization  of  the  con- 
fidential relation  of  the  profession  with  the  people-at-large, 
in  whose  interest  and  for  whose  protection  this  statute  has 
been  enacted.  It  is  the  assertion  of  one  of  the  highest  pre- 
rogatives of  the  medical  profession  and  the  reassurance  of  its 
fidelity  to  the  sacred  obligation  of  inviolability  of  professional 
confidence. 

At  the  meeting  held  January  22, 1896,  this  Society  adopted 
a  series  of  propositions  relating  to  the  sanitation  of  this  city, 
setting  forth  the  necessity  of  extension  and  purification  of  the 
water-supply,  extension  and  completion  of  a  system  of  foul- 
water  and  sewage  disposal,  and  compulsory  connection  of 
habitable  and  inhabited  houses  with  such  systems  of  water- 
supply  and  sewerage.  At  the  same  time  it  charged  the  Com- 
mittee on  Legislation  with  the  duty  of  presenting  these  propo- 
sitions to  Congress  and  urging  the  necessary  legislation.  Of 
these  propositions  one  has  become  a  law,  and  the  one  that 
most  directly  challenges  the  prejudice  and  antagonism  of  the 
unfortunate,  poorer,  and  unhygienic  classes  of  the  popula- 
tion, and  the  only  one  that  charges  its  cost  upon  the  lot- 
holders,  and  holds  the  owner  responsible  for  its  execution. 
As  a  purely  sanitary  measure  the  compulsory  connection  of 
habitable  and  inhabited  houses  with  the  systems  of  water- 
supply  and  sewers  is,  perhaps,  most  important  in  promoting 


378  ESSAYS  AND  ADDRESSES. 

*he  hygiene  of  person  and  dwelling,  and  in  the  prevention 
of  soil-pollution  because  of  the  consequent  abolishment  of 
privy-boxes,  cesspools,  and  other  makeshifts  for  the  collec- 
tion of  human  excreta.  We  also  have  reason  to  believe  that 
the  facts  and  arguments  presented  to  the  respective  Congres- 
sional committees  carried  sufficient  weight  to  secure  fair 
appropriations,  and  have  thus  enabled  the  Commissioners  to 
provide  for  the  extension  of  suburban  sewers  and  supply 
residents  of  Bright  wood  and  Takoma  with  Potomac  water. 
Surely,  then,  notwithstanding  the  faikire  of  our  effort  in  the 
aggregate,  we  have  reason  to  congratulate  ourselves  and  the 
people  of  the  city  upon  the  prospective  improvement  in  the 
sanitation  of  the  city  and  health  of  its  residents.  But  our 
duty  to  the  public  will  not  be  fully  discharged  until  such 
additional  legislation  is  secured  as  will  complete  the  systems 
of  a  pure  water-supply  and  for  the  ultimate  disposal  of 
sewage. 

I  will  not  disguise  the  pride  I  take  in  adding  these  enact- 
ments to  the  record  of  reforms  inaugurated  during  my 
incumbency  of  the  presidency  of  this  Society,  nor  conceal 
the  pleasure  it  gives  me  to  realize  the  fulfilment,  though 
incomplete,  of  our  duty  in  conservation  of  the  health,  well- 
being,  and  happiness  of  this  people.  Much  remains  to  be 
done.  The  education  of  the  general  public  in  sanitation  is 
a  slow  and  tedious  process,  but  the  profession  must  continue 
to  lead  and  direct  popular  opinion  in  all  matters  pertaining 
to  the  knowledge  and  advancement  of  sanitary  science  and 
preventive  medicine. 

So  much  for  the  legislative  reforms.  The  history  of  this 
epochal  year  wdll,  however,  be  incomplete  without  special 
reference  to  the  resumption  of  the  systematic  publication  of 
the  transactions  of  the  Society.  The  publication  contem- 
plates the  record  in  a  permanent  form,  accessible  to  our 
successors  and  to  the  p r of ession-at -large,  of  the  scientific 
work  of  its  members,  and  thereby  the  elevation  of  the  stand- 
ing and  the  establishment  of  the  reputation  of  the  Society 


/';s',S',l  YS  AND  ADDIIICSSES.  ;}70 

upon  IIk;  liiirl)((Ht  ])lim(!  of  Hcicniillc  mikI  iliiiii:il  niPflifine.  I 
luivo,  on  ;i  I'orrrKjr  ocrasion,  expresso'l  tlif  o|>inion  tliut  the 
work  of  (lie  TTHiinhcr.s  of  tliis  S()(;i<!i,y  will  rorn|»;irf  favorably 
witli  tliat  of  any  medical  organization  in  tliis  conntry.  I  am 
assured  now  that  it  will  attain  and  maintain  th«  position  to 
wliich  it  is  entitled,  which  will  redound  to  the  honor  of  its 
membership. 

The  present  plan  and  arrangement  may  be  incomplete  in 
some  details,  but  it  will  contribute  to  the  permanent  estab- 
lishment and  enlarged  usefulness  of  a  local  medical  journal, 
in  some  measure  under  the  control  of  the  Committee  of 
Editors,  a  desideratum  second  only  in  importance  to  the  per- 
manent preservation  of  the  transactions  of  the  Society,  and 
alike  contributory  to  the  fulfilment  of  the  charter-declaration 
to  promote  and  disseminate  medical  and  surgical  knowledge. 
Mark  you  the  significance  of  the  provisions  of  the  charter, 
that  authorizes  and  directs  the  body  corporate  to  "  alien,  sell, 
transfer,  or  lease  "  any  property  or  securities  acquired  by 
''gift,  bargain,  sale,  or  demise,"  ''and  apply  to  such  pur- 
poses as  they  may  judge  most  conducive  to  the  promoting 
and  disseminating  medical  and  surgical  knowledge,  and  for 
no  other  purjiosc  whatsoever." 

The  repealing  section  of  the  Medical  Practice  Act  elimi- 
nates from  the  charter  every  franchise  of  object  and  purpose 
except  the  duty  of  "  promoting  and  disseminating  medical 
and  surgical  knowledge "  in  such  manner  as  the  Society 
"  may  adjudge  most  conducive."  The  scheme  and  plan  of 
publication  adopted,  if  not  adequate  to  the  complete  discharge 
of  such  duty,  is  an  eifort  in  that  direction,  which  can  be  j>er- 
fected  as  expcrieuce  may  indicate  its  defects  and  insufficien- 
cies. It  may  not  be  the  only  method,  but  it  is  one  that  will 
disseminate  medical  and  surgical  kuowledge.  For  many 
years  this  Society  has  restricted  its  scientitic  work  to  such 
consideration  within  closed  doors.  Now  it  has  emphasized 
the  beginniug  of  a  new  era  by  the  extension  of  its  advantages 
to  others  than  those  who  may  regularly  attend   its  weekly 


380  ESSAYS  AND  ADDRESSES. 

meetings.  Every  practitioner  of  medicine  mnst  know  that 
the  present  progress  of  scientific  medicine  throughout  the 
civilized  world  is  due  mainly  to  the  widespread  dissemination 
of  discovery  and  knowledge  through  the  mediums  of  medical 
journals  and  medical  society  publications ;  and  it  is  equally 
true  that  every  such  publication  has,  in  some  measure,  con- 
tributed to  the  diffusion  of  useful  knowledge.  It  must,  then,, 
follow  that  this  Society  can  only  and  completely  discharge  its 
duty  to  the  profession-at-large  and  to  mankind  in  general  by 
the  record  and  publication  of  its  scientific  work.  The  clini- 
cal demonstration  of  the  value  and  utility  of  a  discovery  is 
not  less  important  than  the  discovery.  The  multiplication 
of  clinical  results  obtained  by  different  investigators  in  sepa- 
rate localities,  regions,  and  countries  is  the  only  crucial  and 
conclusive  test  of  the  value,  utility,  and  application  of  new 
facts,  improved  methods,  and  progress.  If  the  transactions 
of  the  Society  were  limited  to  original  thought  and  investiga- 
tion and  discovery,  research  would  continue  without  verifica- 
tion, and  recorded  clinical  observation  and  experience  and 
experimental  attestation  would  be  eliminated  from  the  educa- 
tional facilities  of  organized  effort.  In  1889  a  physician  pub- 
lished the  unsuccessful  results  of  experimental  sponge-grafting 
in  the  orbit  of  a  rabbit.  In  1896  a  member  of  this  Society 
presented  the  history  and  partial  successful  result  of  experi- 
mental sponge-grafting  in  the  human  orbit.  The  conception 
was  original  with  each  experimenter,  the  latter  not  knowing 
the  failure  of  the  first.  Without  publication  of  the  failure 
of  one  and  success  of  the  other,  either  result  might  have  been 
accepted  as  final ;  but  with  all  the  facts  and  data  open  to  all, 
the  priority  of  failure  or  success  will  be  determined  by  the 
clinical  observation  and  experience  of  careful,  painstaking, 
and  competent  observers  who  may  have  preceded  or  will  fol- 
low in  the  same  line  of  investigation.  Such  is  the  rule  and 
conduct  of  medical  workers  to  discover  facts  or  to  co-ordinate 
them  into  laws.  Facts  in  medical  science  and  practice  can 
only  be  established  by  concurrent  investigation,  observation^ 


I'JSSA  VS  AND  A  I> DRESSES.  381 

and  verification  by  '•oiii|)('t(!nl  (;x|)r!rtH.  iSpecaalirtni  in  \ncA\- 
cino  ow(!H  its  nnirvcllons  proKrcss  anrl  |)f)|)nlarity  to  fonron- 
tration  of  effort  and  .syHlcniafic;  |)ubli<;ation.  Gonoral  prac- 
tice owGH  its  decadency  to  desultory  difFusoness  of  thought, 
waste  of  op|)()rtiinity,  and  conij)laisant  disrci^ard  of  progres- 
sive methods.  Tiie  attempt  now  being  made  to  build  upon 
the  ruins  of  its  decay  the  specialism  of  internal  merlicine  can- 
not find  a  region  of  the  hunmn  body  that  has  not  been  in- 
vaded by  an  aggressive  if  not  a  rapacious  sj)ecialism. 

Medical  society  organization  and  consideration,  with  the 
conflict  of  judgment  and  experience,  is  an  active  and  effective 
instrumentality  in  the  correction  of  mistake,  fallacy,  miscon- 
ception, and  misapplication.  All  these  averments  lead  up  to 
and  emphasize  the  postulate  that  the  systematic  record  and 
publication  of  the  scientific  work  of  a  medical  society  are  an 
imperative  duty  to  itself  and  to  the  profession-at-large,  and 
a  potential  auxiliary  to  the  acquisition,  promotion,  and  dis- 
semination of  medical  and  surgical  knowledge.  Then  let  it 
be  our  pride,  as  it  is  our  duty,  to  make  our  transactions  such 
a  repository  of  scientific  and  clinical  knowledge  as  will  reflect 
honor  and  distinction  upon  its  membership. 

The  record  of  this  epoch  year  sets  forth  with  unmistakable 
significance  the  power  and  force  of  a  united  profession,  and 
emphasizes  its  unquestionable  right  to  assert  itself  in  all 
matters  pertaining  to  the  elevation  and  advancement  of  a 
beneficent  and  life-saving  profession,  and  to  the  promotion 
of  the  weKare,  health,  and  longevity  of  the  people.  Through 
all  times  and  among  all  civilized  peoples  the  profession  of 
medicine  has  taken  the  lead  in  all  such  reforms,  and,  when- 
ever and  wherever  it  has  asserted  the  force  and  activity  of 
united  action,  success  has  crowned  its  efforts.  Ghouls,  harpies, 
vampires,  innate  critics,  and  malevolent  satirists  have  feasted 
upon  the  credulity  of  the  ignorant  in  futile  and  venal  struggles 
to  obstruct  and  throttle  progress.  But  scientific  medicine — 
the  handmaid  of  religion  and  benefactor  of  the  human  race — 
has  steadily  advanced  along  the  path  that  leads  to  its  high 


382  ESSA  YS  AND  ADDRESSES. 

goal,  neither  swayefl  by  the  formalities  of  society  uor  dis- 
mayed by  the  convulsions  of  popular  sentiment,  and  now 
commands  the  respect  and  homage  of  the  civilized  world. 
Rancor,  jealousy,  and  dissension  have,  in  times  past,  so  com- 
pletely dissipated  effort  and  influence  that  the  profession  as  a 
body  well-nigh,  for  the  time  beiug,  slunk  iuto  an  occupation 
for  individual  gain  and  emolument  and  personal  aggrandize- 
ment, inciting  ridicule,  popular  prejudice,  and  widespread 
skepticism.  Happily  a  new  era  dawned  in  the  universal 
demand  for  a  higher  standard  of  education  and  qualification, 
and  more  general  and  vigorous  enforcement  of  the  precepts 
of  a  conscientious  and  qualified  discharge  of  the  duties  and 
responsibilities  of  a  beneficent  and  life-saving  science. 

Scientific  medicine  must  fail  in  its  mission  of  humanity  and 
beneficence  in  so  far  as  it  falls  short  of  asserting  the  inalien- 
able right  to  lead,  direct,  control,  and  dominate  popular 
ignorance,  prejudice,  and  cupidity,  to  the  end  that  legislators 
and  all  others  in  authority  must  come  to  know  its  force  and 
power  in  all  things  pertaining  to  the  advancement  of  sani- 
tary science  and  preventive  medicine.  The  art  of  healing 
cannot  be  dissociated  from  the  science  of  prevention.  The 
eradication  of  preventable  diseases  is  the  highest  aim  of 
medical  and  biological  science,  and  to  that  end  research 
must  go  on,  untrammelled  by  authority  and  free  from  the 
restraints  of  malevolent  skepticism. 

The  education  and  betterment  of  the  people-at-large  in 
sanitation  are  not  less  humane  than  the  healing  of  the  sick. 
During  the  past  three  years  this  Society  has  made  creditable 
progress  in  this  department  of  medical  polity,  in  that  it  has 
asserted  its  right,  privilege,  and  duty  to  seek  and  promote 
such  legislation  as  would  conduce  to  the  advancement  of 
scientific  medicine  and  to  the  welfare  of  this  community; 
and  now,  in  the  closing  hour  of  this  session,  it  has  the  proud 
satisfaction  of  summing  up  the  results  of  its  efforts  to  widen 
the  scope  of  its  activities  in  the  interest  of  and  for  the  good 
of  the  people. 


*1>'^ 


^a  v*v 


